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

multicentre, three arm, cluster-randomised controlled trial

Bruce Guthrie (Corresponding Author), Kimberley Kavanagh, Chris Robertson, Karen Barnett, Shaun Treweek, Dennis Petrie, Lewis Ritchie, Marion Bennie

Research output: Contribution to journalArticle

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Abstract

Objective: To evaluate the effectiveness of feedback on safety of prescribing compared with moderately enhanced usual care.

Design: Three arm, highly pragmatic cluster randomised trial.

Setting and participants: 262/278 (94%) primary care practices in three Scottish health boards.

Interventions: Practices were randomised to: “usual care,” consisting of emailed educational material with support for searching to identify patients (88 practices at baseline, 86 analysed); usual care plus feedback on practice’s high risk prescribing sent quarterly on five occasions (87 practices, 86 analysed); or usual care plus the same feedback incorporating a behavioural 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 against usual care at 15 months. Secondary analyses examined immediate change and change in trend of high risk prescribing associated with implementation of the intervention within each arm.

Results: In the primary analysis, high risk prescribing as measured by the primary outcome fell from 6.0% (3332/55 896) to 5.1% (2845/55 872) in the usual care arm, compared with 5.9% (3341/56 194) to 4.6% (2587/56 478) in the feedback only arm (odds ratio 0.88 (95% confidence interval 0.80 to 0.96) compared with usual care; P=0.007) and 6.2% (3634/58 569) to 4.6% (2686/58 582) in the feedback plus behavioural change component arm (0.86 (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 with 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

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Primary Health Care
Randomized Controlled Trials
Safety
Electronic Health Records
Antipsychotic Agents
Anti-Inflammatory Agents
Odds Ratio
Outcome Assessment (Health Care)
Confidence Intervals
Health

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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 (Corresponding Author); Kavanagh, Kimberley; Robertson, Chris; Barnett, Karen; Treweek, Shaun; Petrie, Dennis; Ritchie, Lewis; Bennie, Marion.

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

Research output: Contribution to journalArticle

Guthrie, Bruce ; Kavanagh, Kimberley ; Robertson, Chris ; Barnett, Karen ; Treweek, Shaun ; Petrie, Dennis ; Ritchie, Lewis ; 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.
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abstract = "Objective: To evaluate the effectiveness of feedback on safety of prescribing compared with moderately enhanced usual care.Design: Three arm, highly pragmatic cluster randomised trial.Setting and participants: 262/278 (94{\%}) primary care practices in three Scottish health boards.Interventions: Practices were randomised to: “usual care,” consisting of emailed educational material with support for searching to identify patients (88 practices at baseline, 86 analysed); usual care plus feedback on practice’s high risk prescribing sent quarterly on five occasions (87 practices, 86 analysed); or usual care plus the same feedback incorporating a behavioural 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 against usual care at 15 months. Secondary analyses examined immediate change and change in trend of high risk prescribing associated with implementation of the intervention within each arm.Results: In the primary analysis, high risk prescribing as measured by the primary outcome fell from 6.0{\%} (3332/55 896) to 5.1{\%} (2845/55 872) in the usual care arm, compared with 5.9{\%} (3341/56 194) to 4.6{\%} (2587/56 478) in the feedback only arm (odds ratio 0.88 (95{\%} confidence interval 0.80 to 0.96) compared with usual care; P=0.007) and 6.2{\%} (3634/58 569) to 4.6{\%} (2686/58 582) in the feedback plus behavioural change component arm (0.86 (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 with 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.",
author = "Bruce Guthrie and Kimberley Kavanagh and Chris Robertson and Karen Barnett and Shaun Treweek and Dennis Petrie and Lewis Ritchie and Marion Bennie",
note = "We thank Jackie Caldwell, Iain Bishop, Grant Wyper, Kjersti Fergusson, and Martyn Ritchie in NHS National Services Scotland Information Services Division and all members of the Advisory Group for their contribution. Funding: The study was funded by Scottish Government Chief Scientist Office project grant CZH/3/17. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or the writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. ST works at the Health Services Research Unit, University of Aberdeen, which is funded by the Chief Scientist Office of the Scottish Government Health Directorates.",
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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

AU - Bennie, Marion

N1 - We thank Jackie Caldwell, Iain Bishop, Grant Wyper, Kjersti Fergusson, and Martyn Ritchie in NHS National Services Scotland Information Services Division and all members of the Advisory Group for their contribution. Funding: The study was funded by Scottish Government Chief Scientist Office project grant CZH/3/17. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or the writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. ST works at the Health Services Research Unit, University of Aberdeen, which is funded by the Chief Scientist Office of the Scottish Government Health Directorates.

PY - 2016/8/18

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N2 - Objective: To evaluate the effectiveness of feedback on safety of prescribing compared with moderately enhanced usual care.Design: Three arm, highly pragmatic cluster randomised trial.Setting and participants: 262/278 (94%) primary care practices in three Scottish health boards.Interventions: Practices were randomised to: “usual care,” consisting of emailed educational material with support for searching to identify patients (88 practices at baseline, 86 analysed); usual care plus feedback on practice’s high risk prescribing sent quarterly on five occasions (87 practices, 86 analysed); or usual care plus the same feedback incorporating a behavioural 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 against usual care at 15 months. Secondary analyses examined immediate change and change in trend of high risk prescribing associated with implementation of the intervention within each arm.Results: In the primary analysis, high risk prescribing as measured by the primary outcome fell from 6.0% (3332/55 896) to 5.1% (2845/55 872) in the usual care arm, compared with 5.9% (3341/56 194) to 4.6% (2587/56 478) in the feedback only arm (odds ratio 0.88 (95% confidence interval 0.80 to 0.96) compared with usual care; P=0.007) and 6.2% (3634/58 569) to 4.6% (2686/58 582) in the feedback plus behavioural change component arm (0.86 (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 with 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 - Objective: To evaluate the effectiveness of feedback on safety of prescribing compared with moderately enhanced usual care.Design: Three arm, highly pragmatic cluster randomised trial.Setting and participants: 262/278 (94%) primary care practices in three Scottish health boards.Interventions: Practices were randomised to: “usual care,” consisting of emailed educational material with support for searching to identify patients (88 practices at baseline, 86 analysed); usual care plus feedback on practice’s high risk prescribing sent quarterly on five occasions (87 practices, 86 analysed); or usual care plus the same feedback incorporating a behavioural 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 against usual care at 15 months. Secondary analyses examined immediate change and change in trend of high risk prescribing associated with implementation of the intervention within each arm.Results: In the primary analysis, high risk prescribing as measured by the primary outcome fell from 6.0% (3332/55 896) to 5.1% (2845/55 872) in the usual care arm, compared with 5.9% (3341/56 194) to 4.6% (2587/56 478) in the feedback only arm (odds ratio 0.88 (95% confidence interval 0.80 to 0.96) compared with usual care; P=0.007) and 6.2% (3634/58 569) to 4.6% (2686/58 582) in the feedback plus behavioural change component arm (0.86 (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 with 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.

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DO - 10.1136/bmj.i4079

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JO - BMJ

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