High-risk Prescribing in Nursing Homes
Conditions
Brief summary
Health Quality Ontario (HQO) is the provincial advisor on quality in health care. HQO currently conducts audit and feedback as a key quality improvement strategy. For example, it offers physicians working in long-term care homes with access to practice reports detailing rates of high-risk prescribing in comparison with others in Ontario and suggested change ideas. Research shows that providing this kind of feedback can lead to improvements in care. However, the size of these improvements depends how the feedback is presented. For instance, prior research suggests that how the results are 'framed' and what sort of benchmark the recipient is compared to may each affect how the physician will respond. This factorial trial tests each of these aspects of feedback design in the context of practice reports that nursing home physicians have already signed up to receive quarterly.
Interventions
BEHAVIORALAudit and Feedback
Sponsors
Health Quality Ontario
Women's College Hospital
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* a physician licensed by the College of Physicians and Surgeons of Ontario (CPSO); * practice in at least one LTC facility in Ontario;. * have voluntarily signed up to receive an HQO practice report
Exclusion criteria
* n/a
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| CNS-active medication prescribing | 6 months | monthly number of CNS-active medications per resident (antipsychotics, opioids, benzodiazepines or antidepressants (including TCAs and trazodone)) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Benzodiazepine (or z-drug) rates | 6 months | monthly proportion |
| Antipsychotic rates | 6 months | monthly proportion |
| Antipsychotic prescribing | 6 months | days supplied (continuous) |
| Mean Antipsychotic dose | 6 months | Dose equivalent of antipsychotic dispensed (continuous) |
| Benzodiazepine (or z-drug) prescribing | 6 months | days supplied (continuous) |
| 3+ CNS-active medications | 6 months | monthly proportion supplied three or more meds from the following classes: antipsychotics, opioids, benzodiazepines, or antidepressants (including TCAs and trazodone). |
| Anti-depressant prescribing | 6 months | days supplied (continuous) - balance measure |
| Anti-acid prescribing | 6 months | days supplied (continuous) - tracer outcome |
| Statin prescribing | 6 months | days supplied (continuous) - tracer outcome |
| Mean Benzodiazepine dose | 6 months | Dose equivalent of benzodiazepine dispensed (continuous) |
Countries
Canada
Outcome results
None listed