Physician's Practice Patterns
Conditions
Keywords
Professional Practice, General Practitioners, Inappropriate Prescribing, Persuasive Communication, Information Theory, Feedback
Brief summary
This is a randomised controlled study to evaluate the effect of providing prescribing feedback that includes individual patient data to General Practitioners (GP) in Scotland on high risk or low quality prescribing.
Detailed description
This study makes use of data held in the Prescription Information System (PIS), the national database available to national health service (NHS) health boards in Scotland, on all prescriptions dispensed by community pharmacists which include the unique patient identifier for Scotland (CHI). The design is a two parallel arm cluster randomised trial with general practices as the unit of randomisation to whom the feedback intervention is directed, and outcomes measured at patient level. Both arms receive the same active interventions but focused on different topics, with each acting as control to the other. The primary outcome in the asthma arm is a composite of measure of potentially high-risk asthma prescribing (multiple short acting beta-agonists or single agent long acting beta-agonists both in the absence of inhaled corticosteroid therapy). The primary outcome in the urinary tract infection antibiotic arm is a measure of repeated use of single (likely long-term prevention) or multiple (repeated treatment courses) urinary tract infection antibiotics. Within the feedback, alongside the patient-level analysis, there will be action-orientated messages to guide the GP practice. GP practices will get the reports three times at six-monthly intervals.
Interventions
BEHAVIORALPrescription Data Feedback to GP Practices
GP practices will be randomly assigned to receive reports on one of the two topics. They will get these three times at six-monthly intervals. Within the feedback, alongside the patient-level analysis, there will be action-orientated messages to guide the GP practice.
Sponsors
NHS Greater Glasgow and Clyde
University of Dundee
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* GP practices in the participating Health Board area (NHS Greater Glasgow and Clyde)
Exclusion criteria
* GP practices with registered list sizes \<250 patients (all of these are unusual practices in various ways, for example serving the homeless or people with challenging behaviour). * GP practices with \<80% of prescriptions for inhaled bronchodilators and UTI antibiotics in the prescription database with a recorded patient identifier for each month from January 2014 to December 2014. * GP practices which were created after 1 January 2015.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Number of people identified by the measures of high risk or low quality prescribing | 12 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cost-effectiveness of feedback | 12 months | The economic evaluation will estimate costs and benefits using the cost perspective of the NHS, it will take account medicines cost, costs within the GP practice and use of other NHS services. |
Countries
United Kingdom
Outcome results
None listed