Sarah L Alderson1, Alexander Bald2, Paul Carder3, Amanda Farrin4, Robbie Foy5. 1. Leeds Institute of Health Science, University of Leeds, Leeds, UK. s.l.alderson@leeds.ac.uk. 2. School of Medicine, University of Leeds, Leeds, UK. 3. West Yorkshire Research and Development, NHS Bradford District and Craven Clinical Commissioning Group, Bradford, UK. 4. Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK. 5. Leeds Institute of Health Science, University of Leeds, Leeds, UK.
Abstract
BACKGROUND: There is a significant variation among individual primary care providers in prescribing of potentially problematic, low-value medicines which cause avoidable patient harm. Audit and feedback is generally effective at improving prescribing. However, progress has been hindered by research waste, leading to unanswered questions about how to include audit and feedback for specific problems and circumstances. Trials of different ways of providing audit and feedback in implementation laboratories have been proposed as a way of improving population healthcare while generating robust evidence on feedback effects. However, there is limited experience in their design and delivery. AIM: To explore priorities, feasibility, and ethical challenges of establishing a primary care prescribing audit and feedback implementation laboratory. DESIGN AND SETTING: Two-stage Delphi consensus process involving primary care pharmacy leads, audit and feedback researchers, and patient and public. METHOD: Participants initially scored statements relating to priorities, feasibility, and ethical considerations for an implementation laboratory. These covered current feedback practice, priority topics for feedback, usefulness of feedback in improving prescribing and different types of prescribing data, acceptability and desirability of different organization levels of randomization, options for trial consent, different methods of delivering feedback, and interest in finding out how effective different ways of presenting feedback would be. After receiving collated results, participants then scored the items again. The consensus was defined using the GRADE criteria. The results were analyzed by group and overall score. RESULTS: Fourteen participants reached consensus for 38 out of 55 statements. Addressing antibiotic and opioid prescribing emerged as the highest priorities for action. The panel supported statements around addressing high-priority prescribing issues, taking an "opt-out" approach to practice consent if waiving consent was not permitted, and randomizing at lower rather than higher organizational levels. Participants supported patient-level prescribing data and further research evaluating most of the different feedback methods we presented them with. CONCLUSIONS: There is a good level of support for evaluating a wide range of potential enhancements to improve the effects of feedback on prescribing. The successful design and delivery of a primary care audit and feedback implementation laboratory depend on identifying shared priorities and addressing practical and ethical considerations.
BACKGROUND: There is a significant variation among individual primary care providers in prescribing of potentially problematic, low-value medicines which cause avoidable patient harm. Audit and feedback is generally effective at improving prescribing. However, progress has been hindered by research waste, leading to unanswered questions about how to include audit and feedback for specific problems and circumstances. Trials of different ways of providing audit and feedback in implementation laboratories have been proposed as a way of improving population healthcare while generating robust evidence on feedback effects. However, there is limited experience in their design and delivery. AIM: To explore priorities, feasibility, and ethical challenges of establishing a primary care prescribing audit and feedback implementation laboratory. DESIGN AND SETTING: Two-stage Delphi consensus process involving primary care pharmacy leads, audit and feedback researchers, and patient and public. METHOD:Participants initially scored statements relating to priorities, feasibility, and ethical considerations for an implementation laboratory. These covered current feedback practice, priority topics for feedback, usefulness of feedback in improving prescribing and different types of prescribing data, acceptability and desirability of different organization levels of randomization, options for trial consent, different methods of delivering feedback, and interest in finding out how effective different ways of presenting feedback would be. After receiving collated results, participants then scored the items again. The consensus was defined using the GRADE criteria. The results were analyzed by group and overall score. RESULTS: Fourteen participants reached consensus for 38 out of 55 statements. Addressing antibiotic and opioid prescribing emerged as the highest priorities for action. The panel supported statements around addressing high-priority prescribing issues, taking an "opt-out" approach to practice consent if waiving consent was not permitted, and randomizing at lower rather than higher organizational levels. Participants supported patient-level prescribing data and further research evaluating most of the different feedback methods we presented them with. CONCLUSIONS: There is a good level of support for evaluating a wide range of potential enhancements to improve the effects of feedback on prescribing. The successful design and delivery of a primary care audit and feedback implementation laboratory depend on identifying shared priorities and addressing practical and ethical considerations.
Authors: Ivan R Diamond; Robert C Grant; Brian M Feldman; Paul B Pencharz; Simon C Ling; Aideen M Moore; Paul W Wales Journal: J Clin Epidemiol Date: 2014-04 Impact factor: 6.437
Authors: Sean MacBride-Stewart; Charis Marwick; Neil Houston; Iain Watt; Andrea Patton; Bruce Guthrie Journal: Br J Gen Pract Date: 2017-03-27 Impact factor: 5.386
Authors: Kara A Gray-Burrows; Thomas A Willis; Robbie Foy; Martin Rathfelder; Pauline Bland; Allison Chin; Susan Hodgson; Gus Ibegbuna; Graham Prestwich; Kirsty Samuel; Laurence Wood; Farhat Yaqoob; Rosemary R C McEachan Journal: BMJ Qual Saf Date: 2018-04-17 Impact factor: 7.035
Authors: Rachel Flynn; Stephanie P Brooks; Denise Thomson; Gabrielle L Zimmermann; David Johnson; Tracy Wasylak Journal: Int J Environ Res Public Health Date: 2021-12-01 Impact factor: 3.390