Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS)

multicentre, three arm, cluster randomised controlled trial

Bruce Guthrie (Lead / Corresponding author), Kimberley Kavanagh, Chris Robertson, Karen Barnett, Shaun Treweek, Dennis Petrie, Lewis D. Ritchie, Marion Bennie

    Research output: Contribution to journalArticle

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    Abstract

    Objectives: High-risk prescribing in primary care is common and causes significant harm. Data feedback has been shown to be effective in many contexts, but not for prescribing safety. The aim of this study was to evaluate the effectiveness of prescribing safety feedback compared to moderately enhanced usual care.
    Design: Three-arm, highly pragmatic cluster-randomised trial. Practices were randomised to one of three arms by an independent statistician. Allocation was masked to the research team throughout. Analysis was intention to treat, included all eligible patients at every time point, and was adjusted for practice baseline rates for each outcome. There were no protocol changes after the trial started.Setting and participants: 262/278 (94.2%) primary care practices in three Scottish Health Boards.
    Interventions: Practices were randomised to: (1) ‘usual care’ consisting of e-mailed educational material with support for searching to identify patients (88 practices at baseline, 86 analysed; (2) usual care plus feedback on practice high-risk prescribing sent quarterly on five occasions (87 practices, 86 analysed), or (3) usual care plus the same feedback incorporating a behaviour change component (87 practices, 86 analysed).
    Main outcome measures: The primary outcome was a patient-level composite of six prescribing measures relating to high-risk use of antipsychotics, non-steroidal anti-inflammatories and antiplatelets. Secondary outcomes were the six individual measures. The primary analysis compared high-risk prescribing in the two feedback arms to usual care at 15 months. Secondary analysis examined immediate change and change in trend of high-risk prescribing associated with intervention implementation within each arm.
    Results: In the primary analysis, high-risk prescribing measured by the primary outcome fell from 6.0% to 5.0% in the usual care arm, compared to 6.0% to 4.5% in the feedback-only arm (OR 0.88 compared to usual care, 95%CI 0.80 to 0.96, p=0.007) and 6.2% to 4.5% in the feedback plus behaviour change component (OR 0.86, 95%CI 0.78 to 0.95, p=0.002). In the pre-specified secondary analysis of change in trend within each arm, the usual care educational intervention had no effect on the existing declining trend in high-risk prescribing. Both types of feedback were associated with significantly more rapid decline in high-risk prescribing after the intervention compared to before.
    Conclusions: Feedback of prescribing safety data was effective at reducing high-risk prescribing. The intervention would be feasible to implement at scale in contexts where electronic health records are in general use.
    Original languageEnglish
    Article numberi4079
    Pages (from-to)1-9
    Number of pages9
    JournalBMJ
    Volume354
    DOIs
    Publication statusPublished - 18 Aug 2016

    Fingerprint

    Primary Health Care
    Randomized Controlled Trials
    Safety
    Intention to Treat Analysis
    Electronic Health Records
    Antipsychotic Agents
    Anti-Inflammatory Agents
    Outcome Assessment (Health Care)
    Health
    Research

    Keywords

    • General Practice
    • Family Practice
    • Quality Improvement
    • Quality Indicators
    • Health Care
    • Inappropriate Prescribing
    • Prescribing Safety
    • Feedback
    • Randomised Controlled Trial

    Cite this

    Guthrie, Bruce ; Kavanagh, Kimberley ; Robertson, Chris ; Barnett, Karen ; Treweek, Shaun ; Petrie, Dennis ; Ritchie, Lewis D. ; Bennie, Marion. / Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS) : multicentre, three arm, cluster randomised controlled trial. In: BMJ. 2016 ; Vol. 354. pp. 1-9.
    @article{5010393e07884ca5948bdda839f9284e,
    title = "Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS): multicentre, three arm, cluster randomised controlled trial",
    abstract = "Objectives: High-risk prescribing in primary care is common and causes significant harm. Data feedback has been shown to be effective in many contexts, but not for prescribing safety. The aim of this study was to evaluate the effectiveness of prescribing safety feedback compared to moderately enhanced usual care.Design: Three-arm, highly pragmatic cluster-randomised trial. Practices were randomised to one of three arms by an independent statistician. Allocation was masked to the research team throughout. Analysis was intention to treat, included all eligible patients at every time point, and was adjusted for practice baseline rates for each outcome. There were no protocol changes after the trial started.Setting and participants: 262/278 (94.2{\%}) primary care practices in three Scottish Health Boards. Interventions: Practices were randomised to: (1) ‘usual care’ consisting of e-mailed educational material with support for searching to identify patients (88 practices at baseline, 86 analysed; (2) usual care plus feedback on practice high-risk prescribing sent quarterly on five occasions (87 practices, 86 analysed), or (3) usual care plus the same feedback incorporating a behaviour change component (87 practices, 86 analysed). Main outcome measures: The primary outcome was a patient-level composite of six prescribing measures relating to high-risk use of antipsychotics, non-steroidal anti-inflammatories and antiplatelets. Secondary outcomes were the six individual measures. The primary analysis compared high-risk prescribing in the two feedback arms to usual care at 15 months. Secondary analysis examined immediate change and change in trend of high-risk prescribing associated with intervention implementation within each arm. Results: In the primary analysis, high-risk prescribing measured by the primary outcome fell from 6.0{\%} to 5.0{\%} in the usual care arm, compared to 6.0{\%} to 4.5{\%} in the feedback-only arm (OR 0.88 compared to usual care, 95{\%}CI 0.80 to 0.96, p=0.007) and 6.2{\%} to 4.5{\%} in the feedback plus behaviour change component (OR 0.86, 95{\%}CI 0.78 to 0.95, p=0.002). In the pre-specified secondary analysis of change in trend within each arm, the usual care educational intervention had no effect on the existing declining trend in high-risk prescribing. Both types of feedback were associated with significantly more rapid decline in high-risk prescribing after the intervention compared to before.Conclusions: Feedback of prescribing safety data was effective at reducing high-risk prescribing. The intervention would be feasible to implement at scale in contexts where electronic health records are in general use.",
    keywords = "General Practice, Family Practice, Quality Improvement, Quality Indicators, Health Care, Inappropriate Prescribing, Prescribing Safety, Feedback, Randomised Controlled Trial",
    author = "Bruce Guthrie and Kimberley Kavanagh and Chris Robertson and Karen Barnett and Shaun Treweek and Dennis Petrie and Ritchie, {Lewis D.} and Marion Bennie",
    year = "2016",
    month = "8",
    day = "18",
    doi = "10.1136/bmj.i4079",
    language = "English",
    volume = "354",
    pages = "1--9",
    journal = "British Medical Journal",
    issn = "0959-8146",
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    Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS) : multicentre, three arm, cluster randomised controlled trial. / Guthrie, Bruce (Lead / Corresponding author); Kavanagh, Kimberley; Robertson, Chris; Barnett, Karen; Treweek, Shaun; Petrie, Dennis; Ritchie, Lewis D.; Bennie, Marion.

    In: BMJ, Vol. 354, i4079, 18.08.2016, p. 1-9.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS)

    T2 - multicentre, three arm, cluster randomised controlled trial

    AU - Guthrie, Bruce

    AU - Kavanagh, Kimberley

    AU - Robertson, Chris

    AU - Barnett, Karen

    AU - Treweek, Shaun

    AU - Petrie, Dennis

    AU - Ritchie, Lewis D.

    AU - Bennie, Marion

    PY - 2016/8/18

    Y1 - 2016/8/18

    N2 - Objectives: High-risk prescribing in primary care is common and causes significant harm. Data feedback has been shown to be effective in many contexts, but not for prescribing safety. The aim of this study was to evaluate the effectiveness of prescribing safety feedback compared to moderately enhanced usual care.Design: Three-arm, highly pragmatic cluster-randomised trial. Practices were randomised to one of three arms by an independent statistician. Allocation was masked to the research team throughout. Analysis was intention to treat, included all eligible patients at every time point, and was adjusted for practice baseline rates for each outcome. There were no protocol changes after the trial started.Setting and participants: 262/278 (94.2%) primary care practices in three Scottish Health Boards. Interventions: Practices were randomised to: (1) ‘usual care’ consisting of e-mailed educational material with support for searching to identify patients (88 practices at baseline, 86 analysed; (2) usual care plus feedback on practice high-risk prescribing sent quarterly on five occasions (87 practices, 86 analysed), or (3) usual care plus the same feedback incorporating a behaviour change component (87 practices, 86 analysed). Main outcome measures: The primary outcome was a patient-level composite of six prescribing measures relating to high-risk use of antipsychotics, non-steroidal anti-inflammatories and antiplatelets. Secondary outcomes were the six individual measures. The primary analysis compared high-risk prescribing in the two feedback arms to usual care at 15 months. Secondary analysis examined immediate change and change in trend of high-risk prescribing associated with intervention implementation within each arm. Results: In the primary analysis, high-risk prescribing measured by the primary outcome fell from 6.0% to 5.0% in the usual care arm, compared to 6.0% to 4.5% in the feedback-only arm (OR 0.88 compared to usual care, 95%CI 0.80 to 0.96, p=0.007) and 6.2% to 4.5% in the feedback plus behaviour change component (OR 0.86, 95%CI 0.78 to 0.95, p=0.002). In the pre-specified secondary analysis of change in trend within each arm, the usual care educational intervention had no effect on the existing declining trend in high-risk prescribing. Both types of feedback were associated with significantly more rapid decline in high-risk prescribing after the intervention compared to before.Conclusions: Feedback of prescribing safety data was effective at reducing high-risk prescribing. The intervention would be feasible to implement at scale in contexts where electronic health records are in general use.

    AB - Objectives: High-risk prescribing in primary care is common and causes significant harm. Data feedback has been shown to be effective in many contexts, but not for prescribing safety. The aim of this study was to evaluate the effectiveness of prescribing safety feedback compared to moderately enhanced usual care.Design: Three-arm, highly pragmatic cluster-randomised trial. Practices were randomised to one of three arms by an independent statistician. Allocation was masked to the research team throughout. Analysis was intention to treat, included all eligible patients at every time point, and was adjusted for practice baseline rates for each outcome. There were no protocol changes after the trial started.Setting and participants: 262/278 (94.2%) primary care practices in three Scottish Health Boards. Interventions: Practices were randomised to: (1) ‘usual care’ consisting of e-mailed educational material with support for searching to identify patients (88 practices at baseline, 86 analysed; (2) usual care plus feedback on practice high-risk prescribing sent quarterly on five occasions (87 practices, 86 analysed), or (3) usual care plus the same feedback incorporating a behaviour change component (87 practices, 86 analysed). Main outcome measures: The primary outcome was a patient-level composite of six prescribing measures relating to high-risk use of antipsychotics, non-steroidal anti-inflammatories and antiplatelets. Secondary outcomes were the six individual measures. The primary analysis compared high-risk prescribing in the two feedback arms to usual care at 15 months. Secondary analysis examined immediate change and change in trend of high-risk prescribing associated with intervention implementation within each arm. Results: In the primary analysis, high-risk prescribing measured by the primary outcome fell from 6.0% to 5.0% in the usual care arm, compared to 6.0% to 4.5% in the feedback-only arm (OR 0.88 compared to usual care, 95%CI 0.80 to 0.96, p=0.007) and 6.2% to 4.5% in the feedback plus behaviour change component (OR 0.86, 95%CI 0.78 to 0.95, p=0.002). In the pre-specified secondary analysis of change in trend within each arm, the usual care educational intervention had no effect on the existing declining trend in high-risk prescribing. Both types of feedback were associated with significantly more rapid decline in high-risk prescribing after the intervention compared to before.Conclusions: Feedback of prescribing safety data was effective at reducing high-risk prescribing. The intervention would be feasible to implement at scale in contexts where electronic health records are in general use.

    KW - General Practice

    KW - Family Practice

    KW - Quality Improvement

    KW - Quality Indicators

    KW - Health Care

    KW - Inappropriate Prescribing

    KW - Prescribing Safety

    KW - Feedback

    KW - Randomised Controlled Trial

    U2 - 10.1136/bmj.i4079

    DO - 10.1136/bmj.i4079

    M3 - Article

    VL - 354

    SP - 1

    EP - 9

    JO - British Medical Journal

    JF - British Medical Journal

    SN - 0959-8146

    M1 - i4079

    ER -