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

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  • 1Quality, Safety and Informatics Group, Population Health Sciences, Medical Research Institute, University of Dundee, Dundee, UK.

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|January 23, 2014
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Summary

The study found that non-steroidal anti-inflammatory drug (NSAID) and antiplatelet prescribing measures were most effective for quality improvement. These measures identified high-risk prescribing that clinicians could change, informing the data-driven quality improvement in primary care (DQIP) intervention.

Keywords:
Clinical Pharmacology

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Area of Science:

  • Primary care quality improvement
  • Medication safety
  • Health services research

Background:

  • Assessing the effectiveness of quality improvement interventions in primary care is crucial for enhancing patient safety and optimizing resource allocation.
  • Data-driven quality improvement (DQIP) interventions aim to reduce potentially harmful prescribing practices.

Purpose of the Study:

  • To evaluate candidate outcome measures for identifying high-risk prescribing amenable to change by a DQIP intervention.
  • To explore clinicians' perceptions of reviewing identified high-risk prescribing.
  • To optimize the components of the DQIP intervention for future implementation.

Main Methods:

  • A mixed-methods study was conducted in four general practices across two Scottish Health Boards.
  • Prescribing measures targeted high-risk use of NSAIDs, antiplatelets, asthma control, and antithrombotics in atrial fibrillation (AF).
  • Quantitative data on the proportion of patients requiring action were collected, alongside qualitative data from staff interviews and field notes.

Main Results:

  • Practices identified a need for action in 68% of patients for NSAID/antiplatelet prescribing, 25% for asthma control, and 18% for antithrombotics in AF.
  • General practitioners found prompts to review patients valuable, particularly for NSAID/antiplatelet and antithrombotic in AF prescribing.
  • Barriers to engagement and sustained prescribing improvements were identified.

Conclusions:

  • The NSAID and antiplatelet prescribing measures were deemed most suitable for the DQIP trial due to their potential for change.
  • The DQIP intervention was refined to include financial incentives, ongoing feedback, and re-prompting for patients with restarted high-risk prescribing.
  • These optimizations aim to enhance the effectiveness and sustainability of the DQIP intervention in primary care settings.