Audit and feedback interventions involving pharmacists to influence prescribing behaviour in general practice: a systematic review and meta-analysis

Mary Carter; Nouf Abutheraa; Noah Ivers; Jeremy Grimshaw; Sarah Chapman; Philip Rogers; Michelle Simeoni; Jesmin Antony; Margaret C Watson

doi:10.1093/fampra/cmac150

Audit and feedback interventions involving pharmacists to influence prescribing behaviour in general practice: a systematic review and meta-analysis

Mary Carter^* (Corresponding Author), Nouf Abutheraa, Noah Ivers, Jeremy Grimshaw, Sarah Chapman, Philip Rogers, Michelle Simeoni, Jesmin Antony, Margaret C Watson

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

INTRODUCTION: Pharmacists, as experts in medicines, are increasingly employed in general practices and undertake a range of responsibilities. Audit and feedback (A&F) interventions are effective in achieving behaviour change, including prescribing. The extent of pharmacist involvement in A&F interventions to influence prescribing is unknown. This review aimed to assess the effectiveness of A&F interventions involving pharmacists on prescribing in general practice compared with no A&F/usual care and to describe features of A&F interventions and pharmacist characteristics.

METHODS: Electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, (Social) Science Citation Indexes, ISI Web of Science) were searched (2012, 2019, 2020). Cochrane systematic review methods were applied to trial identification, selection, and risk of bias. Results were summarized descriptively and heterogeneity was assessed. A random-effects meta-analysis was conducted where studies were sufficiently homogenous in design and outcome.

RESULTS: Eleven cluster-randomized studies from 9 countries were included. Risk of bias across most domains was low. Interventions focussed on older patients, specific clinical area(s), or specific medications. Meta-analysis of 6 studies showed improved prescribing outcomes (pooled risk ratio: 0.78, 95% confidence interval: 0.64-0.94). Interventions including both verbal and written feedback or computerized decision support for prescribers were more effective. Pharmacists who received study-specific training, provided ongoing support to prescribers or reviewed prescribing for individual patients, contributed to more effective interventions.

CONCLUSIONS: A&F interventions involving pharmacists can lead to small improvements in evidence-based prescribing in general practice settings. Future implementation of A&F within general practice should compare different ways of involving pharmacists to determine how to optimize effectiveness.PRISMA-compliant abstract included in Supplementary Material 1.

Original language	English
Article number	cmac150
Pages (from-to)	1-14
Number of pages	14
Journal	Family Practice
Volume	XX
Early online date	12 Jan 2023
DOIs	https://doi.org/10.1093/fampra/cmac150
Publication status	E-pub ahead of print - 12 Jan 2023

Bibliographical note

Acknowledgements
We would like to thank Associate Professor Denise O’Connor and members of the A&F Systematic Review Risk of Bias team (Dr Jia Xi, Dr Sheila Cyril, and Associate Professor Ashley Fletcher) for their contribution to Risk of Bias assessments for this review.

Funding
This work is supported by a PhD Studentship (reference 189447056) awarded to the lead author (MC) by the University of Bath.

Data Availability Statement

Data are available on reasonable request.

Keywords

evidence
general practice
pharmacist
prescribing
primary care
systematic review

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10.1093/fampra/cmac150Licence: CC BY

Carter_etal_FP_Audit_and_Feedback_VOR
© The Author(s) 2023. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
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Carter, M., Abutheraa, N., Ivers, N., Grimshaw, J., Chapman, S., Rogers, P., Simeoni, M., Antony, J., & Watson, M. C. (2023). Audit and feedback interventions involving pharmacists to influence prescribing behaviour in general practice: a systematic review and meta-analysis. Family Practice, XX, 1-14. Article cmac150. Advance online publication. https://doi.org/10.1093/fampra/cmac150

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abstract = "INTRODUCTION: Pharmacists, as experts in medicines, are increasingly employed in general practices and undertake a range of responsibilities. Audit and feedback (A&F) interventions are effective in achieving behaviour change, including prescribing. The extent of pharmacist involvement in A&F interventions to influence prescribing is unknown. This review aimed to assess the effectiveness of A&F interventions involving pharmacists on prescribing in general practice compared with no A&F/usual care and to describe features of A&F interventions and pharmacist characteristics.METHODS: Electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, (Social) Science Citation Indexes, ISI Web of Science) were searched (2012, 2019, 2020). Cochrane systematic review methods were applied to trial identification, selection, and risk of bias. Results were summarized descriptively and heterogeneity was assessed. A random-effects meta-analysis was conducted where studies were sufficiently homogenous in design and outcome.RESULTS: Eleven cluster-randomized studies from 9 countries were included. Risk of bias across most domains was low. Interventions focussed on older patients, specific clinical area(s), or specific medications. Meta-analysis of 6 studies showed improved prescribing outcomes (pooled risk ratio: 0.78, 95% confidence interval: 0.64-0.94). Interventions including both verbal and written feedback or computerized decision support for prescribers were more effective. Pharmacists who received study-specific training, provided ongoing support to prescribers or reviewed prescribing for individual patients, contributed to more effective interventions.CONCLUSIONS: A&F interventions involving pharmacists can lead to small improvements in evidence-based prescribing in general practice settings. Future implementation of A&F within general practice should compare different ways of involving pharmacists to determine how to optimize effectiveness.PRISMA-compliant abstract included in Supplementary Material 1.",

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author = "Mary Carter and Nouf Abutheraa and Noah Ivers and Jeremy Grimshaw and Sarah Chapman and Philip Rogers and Michelle Simeoni and Jesmin Antony and Watson, {Margaret C}",

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doi = "10.1093/fampra/cmac150",

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T1 - Audit and feedback interventions involving pharmacists to influence prescribing behaviour in general practice

T2 - a systematic review and meta-analysis

AU - Carter, Mary

AU - Abutheraa, Nouf

AU - Ivers, Noah

AU - Grimshaw, Jeremy

AU - Chapman, Sarah

AU - Rogers, Philip

AU - Simeoni, Michelle

AU - Antony, Jesmin

AU - Watson, Margaret C

N1 - Acknowledgements We would like to thank Associate Professor Denise O’Connor and members of the A&F Systematic Review Risk of Bias team (Dr Jia Xi, Dr Sheila Cyril, and Associate Professor Ashley Fletcher) for their contribution to Risk of Bias assessments for this review. Funding This work is supported by a PhD Studentship (reference 189447056) awarded to the lead author (MC) by the University of Bath.

PY - 2023/1/12

Y1 - 2023/1/12

N2 - INTRODUCTION: Pharmacists, as experts in medicines, are increasingly employed in general practices and undertake a range of responsibilities. Audit and feedback (A&F) interventions are effective in achieving behaviour change, including prescribing. The extent of pharmacist involvement in A&F interventions to influence prescribing is unknown. This review aimed to assess the effectiveness of A&F interventions involving pharmacists on prescribing in general practice compared with no A&F/usual care and to describe features of A&F interventions and pharmacist characteristics.METHODS: Electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, (Social) Science Citation Indexes, ISI Web of Science) were searched (2012, 2019, 2020). Cochrane systematic review methods were applied to trial identification, selection, and risk of bias. Results were summarized descriptively and heterogeneity was assessed. A random-effects meta-analysis was conducted where studies were sufficiently homogenous in design and outcome.RESULTS: Eleven cluster-randomized studies from 9 countries were included. Risk of bias across most domains was low. Interventions focussed on older patients, specific clinical area(s), or specific medications. Meta-analysis of 6 studies showed improved prescribing outcomes (pooled risk ratio: 0.78, 95% confidence interval: 0.64-0.94). Interventions including both verbal and written feedback or computerized decision support for prescribers were more effective. Pharmacists who received study-specific training, provided ongoing support to prescribers or reviewed prescribing for individual patients, contributed to more effective interventions.CONCLUSIONS: A&F interventions involving pharmacists can lead to small improvements in evidence-based prescribing in general practice settings. Future implementation of A&F within general practice should compare different ways of involving pharmacists to determine how to optimize effectiveness.PRISMA-compliant abstract included in Supplementary Material 1.

AB - INTRODUCTION: Pharmacists, as experts in medicines, are increasingly employed in general practices and undertake a range of responsibilities. Audit and feedback (A&F) interventions are effective in achieving behaviour change, including prescribing. The extent of pharmacist involvement in A&F interventions to influence prescribing is unknown. This review aimed to assess the effectiveness of A&F interventions involving pharmacists on prescribing in general practice compared with no A&F/usual care and to describe features of A&F interventions and pharmacist characteristics.METHODS: Electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, (Social) Science Citation Indexes, ISI Web of Science) were searched (2012, 2019, 2020). Cochrane systematic review methods were applied to trial identification, selection, and risk of bias. Results were summarized descriptively and heterogeneity was assessed. A random-effects meta-analysis was conducted where studies were sufficiently homogenous in design and outcome.RESULTS: Eleven cluster-randomized studies from 9 countries were included. Risk of bias across most domains was low. Interventions focussed on older patients, specific clinical area(s), or specific medications. Meta-analysis of 6 studies showed improved prescribing outcomes (pooled risk ratio: 0.78, 95% confidence interval: 0.64-0.94). Interventions including both verbal and written feedback or computerized decision support for prescribers were more effective. Pharmacists who received study-specific training, provided ongoing support to prescribers or reviewed prescribing for individual patients, contributed to more effective interventions.CONCLUSIONS: A&F interventions involving pharmacists can lead to small improvements in evidence-based prescribing in general practice settings. Future implementation of A&F within general practice should compare different ways of involving pharmacists to determine how to optimize effectiveness.PRISMA-compliant abstract included in Supplementary Material 1.

KW - evidence

KW - general practice

KW - pharmacist

KW - prescribing

KW - primary care

KW - systematic review

U2 - 10.1093/fampra/cmac150

DO - 10.1093/fampra/cmac150

M3 - Article

C2 - 36633309

SN - 0263-2136

VL - XX

SP - 1

EP - 14

JO - Family Practice

JF - Family Practice

M1 - cmac150

ER -

Audit and feedback interventions involving pharmacists to influence prescribing behaviour in general practice: a systematic review and meta-analysis

Abstract

Bibliographical note

Data Availability Statement

Keywords

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