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Cited by 32Pharmaceutical Practices and Patient OutcomesPatient Safety and Medication ErrorsPrimary Care and Health Outcomes

Developing a complex intervention to improve prescribing safety in primary care: mixed methods feasibility and optimisation pilot study

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Grant, Aileen M, Guthrie, Bruce, Dreischulte, Tobias·2014·BMJ Open
DOI 10.1136/bmjopen-2013-004153PMC PMC3902335
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Abstract

Objectives: (A) To measure the extent to which different candidate outcome measures identified high-risk prescribing that is potentially changeable by the data-driven quality improvement in primary care (DQIP) intervention.(B) To explore the value of reviewing identified high-risk prescribing to clinicians.(C) To optimise the components of the DQIP intervention. Design: Mixed method study. Setting: General practices in two Scottish Health boards. Participants: 4 purposively sampled general practices of varying size and socioeconomic deprivation. Outcome measures: Prescribing measures targeting (1) high-risk use of the non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelets; (2) ‘Asthma control’ and (3) ‘Antithrombotics in atrial fibrillation (AF)’. Intervention: The prescribing measures were used to identify patients for review by general practices. The ability of the measures to identify potentially changeable high-risk prescribing was measured as the proportion of patients reviewed where practices identified a need for action. Field notes were recorded from meetings between researchers and staff and key staff participated in semistructured interviews exploring their experience of the piloted intervention processes. Results: Practices identified a need for action in 68%, 25% and 18% of patients reviewed for prescribing measures (1), (2) and (3), respectively. General practitioners valued being prompted to review patients, and perceived that (1) ‘NSAID and antiplatelet’ and (2) ‘antithrombotics in AF’ were the most important to act on. Barriers to initial and ongoing engagement and to sustaining improvements in prescribing were identified. Conclusions: ‘NSAIDs and antiplatelets’ measures were selected as the most suitable outcome measures for the DQIP trial, based on evidence of this prescribing being more easily changeable. In response to the barriers identified, the intervention was designed to include a financial incentive, additional ongoing feedback on progress and reprompting review of patients, whose high-risk prescribing was restarted after a decision to stop. Trial registration number: Clinicaltrials.gov NCT01425502 .

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  • The interventions reported across the review varied widely and included a few targeting behavioural change at the individual patient level, such as weight reduction and smoking cessation programs, or at the level of healthcare professionals, such as interventions targeting general practitioners to reduce inappropriate prescribing behaviours.

    “The interventions reported across the review varied widely and included a few targeting behavioural change at the individual patient level, such as weight reduction [27] and smoking cessation programs [10, 44, 49], or at the level of healthcare professionals, such as interventions targeting general practitioners to reduce inappropriate prescribing behaviours [26, 45, 46, 48].”

    From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [48]

  • The remaining included studies did not specify the guidelines or frameworks adopted to develop the intervention of interest.

    “The remaining studies did not specify the guidelines or frameworks adopted to develop the intervention of interest [48–50].”

    From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [48]

  • Several included studies employed well-established qualitative methods including interviews or focus groups with providers and recipients or relevant stakeholders, and observations and consensus processes including researchers, patients and clinical experts.

    “Several studies employed well-established qualitative methods including interviews or focus groups with providers and recipients or relevant stakeholders [26, 30, 32, 34, 39, 47, 48] and observations and consensus processes including researchers, patients and clinical experts [31].”

    From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [48]

  • Optimisation strategies applying qualitative methods tended to explore acceptability and feasibility issues.

    “Optimisation strategies applying qualitative methods tended to explore acceptability and feasibility issues [26, 30, 32, 34, 39, 47, 48].”

    From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [48]

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Authors
Grant, A. M., Guthrie, B., & Dreischulte, T.
Affiliations
University of Dundee (GB)
Corresponding author
Grant, Aileen M
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2014-01
Volume
4
Issue
1
Pages
e004153
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2013-004153
PMC
PMC3902335
OpenAlex
W2124959039
Cited by
32
References
42
Citations by year
2024: 7 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 1 · 2019: 4 · 2018: 1 · 2017: 4 · 2016: 5 · 2015: 3 · 2014: 1
FWCI
2.21
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Discovery Research Portal (University of Dundee) (publishedVersion, cc-by-nc)
  • Edinburgh Research Explorer (University of Edinburgh) (publishedVersion, other-oa)
  • Open Access Institutional Repository at Robert Gordon University (Robert Gordon University) (publishedVersion, cc-by-nc)
  • Stirling Online Research Repository (University of Stirling) (submittedVersion, cc-by-nc)
  • Open access LMU (Ludwid Maxmilian's Universitat Munchen) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
  • Open Access Institutional Repository at Robert Gordon University (Robert Gordon University) (submittedVersion, cc-by-nc)
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Keywords
prescribing safety, high-risk prescribing, data-driven quality improvement, primary care, general practice, nonsteroidal anti-inflammatory drugs, antiplatelet agents, asthma control, outcome measures, intervention optimization, financial incentives, prescribing feedback, barriers to engagement
MeSH terms
Feasibility Studies, Humans, Pilot Projects, Drug Prescriptions, Primary Health Care, Quality Improvement, Patient Safety

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