Protocol for the Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) study

A cluster randomised controlled trial using ePrescribing data

Bruce Guthrie* (Corresponding Author), Shaun Treweek, Dennis Petrie, Karen Barnett, Lewis D. Ritchie, Chris Robertson, Marion Bennie

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction: High-risk prescribing in primary care is common and causes considerable harm. Feedback interventions to improve care are attractive because they are relatively cheap to widely implement. There is good evidence that feedback has small to moderate effects, but the most recent Cochrane review called for more high-quality, large trials that explicitly test different forms of feedback. Methods and analysis: The study is a three-arm cluster-randomised trial with general practices being randomised and outcomes measured at patient level. 262 practices in three Scottish Health Board areas have been randomised (94% of all possible practices). The two active arms receive different forms of prescribing safety data feedback, with rates of high-risk prescribing compared with a 'usual care' arm. Sample size estimation used baseline data from participating practices. With 85 practices randomised to each arm, then there is 93% power to detect a 25% difference in the percentage of high-risk prescribing (from 6.1% to 4.5%) between the usual care arm and each intervention arm. The primary outcome is a composite of six highrisk prescribing measures (antipsychotic prescribing to people aged ≥75 years; non-steroidal anti-inflammatory drug (NSAID) prescribing to people aged ≥75 without gastroprotection; NSAID prescribing to people prescribed aspirin/clopidogrel without gastroprotection; NSAID prescribing to people prescribed an ACE inhibitor/angiotensin receptor blocker and a diuretic; NSAID prescription to people prescribed an oral anticoagulant without gastroprotection; aspirin/clopidogrel prescription to people prescribed an oral anticoagulant without gastroprotection). The primary analysis will use multilevel modelling to account for repeated measurement of outcomes in patients clustered within practices. Ethics and dissemination: The study was reviewed and approved by the NHS Tayside Committee on Medical Research Ethics B (11/ES/0001). The study will be disseminated via a final report to the funder with a publicly available research summary, and peer reviewed publications.

Original languageEnglish
Article numbere002359
JournalBMJ Open
Volume2
Issue number6
DOIs
Publication statusPublished - 1 Dec 2012

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Drug Prescriptions
clopidogrel
Primary Health Care
Anti-Inflammatory Agents
Randomized Controlled Trials
Safety
Anticoagulants
Aspirin
Research Ethics
Medical Ethics
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Diuretics
Ethics
General Practice
Sample Size
Antipsychotic Agents
Prescriptions
Publications
Biomedical Research

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Protocol for the Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) study : A cluster randomised controlled trial using ePrescribing data. / Guthrie, Bruce (Corresponding Author); Treweek, Shaun; Petrie, Dennis; Barnett, Karen; Ritchie, Lewis D.; Robertson, Chris; Bennie, Marion.

In: BMJ Open, Vol. 2, No. 6, e002359, 01.12.2012.

Research output: Contribution to journalArticle

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abstract = "Introduction: High-risk prescribing in primary care is common and causes considerable harm. Feedback interventions to improve care are attractive because they are relatively cheap to widely implement. There is good evidence that feedback has small to moderate effects, but the most recent Cochrane review called for more high-quality, large trials that explicitly test different forms of feedback. Methods and analysis: The study is a three-arm cluster-randomised trial with general practices being randomised and outcomes measured at patient level. 262 practices in three Scottish Health Board areas have been randomised (94{\%} of all possible practices). The two active arms receive different forms of prescribing safety data feedback, with rates of high-risk prescribing compared with a 'usual care' arm. Sample size estimation used baseline data from participating practices. With 85 practices randomised to each arm, then there is 93{\%} power to detect a 25{\%} difference in the percentage of high-risk prescribing (from 6.1{\%} to 4.5{\%}) between the usual care arm and each intervention arm. The primary outcome is a composite of six highrisk prescribing measures (antipsychotic prescribing to people aged ≥75 years; non-steroidal anti-inflammatory drug (NSAID) prescribing to people aged ≥75 without gastroprotection; NSAID prescribing to people prescribed aspirin/clopidogrel without gastroprotection; NSAID prescribing to people prescribed an ACE inhibitor/angiotensin receptor blocker and a diuretic; NSAID prescription to people prescribed an oral anticoagulant without gastroprotection; aspirin/clopidogrel prescription to people prescribed an oral anticoagulant without gastroprotection). The primary analysis will use multilevel modelling to account for repeated measurement of outcomes in patients clustered within practices. Ethics and dissemination: The study was reviewed and approved by the NHS Tayside Committee on Medical Research Ethics B (11/ES/0001). The study will be disseminated via a final report to the funder with a publicly available research summary, and peer reviewed publications.",
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