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Establishing a primary care audit and feedback implementation laboratory: a consensus study.

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Improving primary care prescribing requires effective audit and feedback. This study explored priorities for an implementation laboratory, finding strong support for addressing antibiotic and opioid prescribing and using patient-level data.

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Area of Science:

  • Health Services Research
  • Implementation Science
  • Primary Care Medicine

Background:

  • Significant variation exists in primary care prescribing of low-value medicines, leading to patient harm.
  • Audit and feedback (A&F) can improve prescribing, but research gaps hinder optimal implementation.
  • Implementation laboratories offer a novel approach to test A&F strategies and generate robust evidence.

Purpose of the Study:

  • To explore priorities, feasibility, and ethical challenges for establishing a primary care prescribing audit and feedback implementation laboratory.
  • To identify key areas for intervention and optimal methods for A&F delivery.
  • To gather consensus on practical and ethical considerations for A&F implementation laboratories.

Main Methods:

  • A two-stage Delphi consensus process was employed.
  • Participants included primary care pharmacy leads, A&F researchers, and patient representatives.
  • Consensus was reached on priorities, feasibility, and ethical considerations using GRADE criteria.

Main Results:

  • Consensus was achieved on 38 out of 55 statements.
  • Antibiotic and opioid prescribing were identified as high-priority areas.
  • Support was found for an opt-out consent approach, lower-level randomization, and patient-level prescribing data.

Conclusions:

  • There is substantial support for evaluating enhancements to A&F to improve prescribing.
  • Successful implementation laboratories require alignment on shared priorities and careful consideration of practical and ethical issues.
  • Further research is warranted to evaluate various feedback methods.