A cluster randomised stepped wedge trial to evaluate the effectiveness of a multifaceted information technology-based intervention in reducing high-risk prescribing of non-steroidal anti-inflammatory drugs and antiplatelets in primary medical care: The DQIP study protocol
A cluster randomised stepped wedge trial to evaluate the effectiveness of a multifaceted information technology-based intervention in reducing high-risk prescribing of non-steroidal anti-inflammatory drugs and antiplatelets in primary medical care: The DQIP study protocol
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DOI：
10.1186/1748-5908-7-24
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发表时间：
2012-03-23
影响因子：
7.2
通讯作者：
Guthrie, Bruce
中科院分区：
文献类型：
--
作者：
Dreischulte, Tobias;Grant, Aileen;Guthrie, Bruce
背景：由于可预防的不良药物事件，非类固醇抗炎药(NSAIDs)和抗血小板药物的高风险处方在住院患者中占很大比例。最近完成的Pincer试验表明，由药剂师领导的基于信息技术(IT)的一次性干预可以显著减少初级保健中的高风险处方，但有证据表明，效果随着时间的推移而减少，雇佣更多的药剂师来促进变化可能是不可持续的。方法/设计：我们将在两个苏格兰卫生委员会的40个志愿者一般做法中进行随机分组对照和阶梯式楔形设计。符合条件的做法是那些正在使用INPS Vision临床IT系统，并同意从其电子医疗记录中自动提取与药物相关的数据的公司。同意参与的所有实践(群组)将接受数据驱动的初级保健质量改进(DQIP)干预，但将随机选择10个开始日期之一。DQIP干预包括三个部分：基于网络的信息工具，提供每周最新的实践层面的有针对性的处方反馈，提示对受影响的个体患者进行审查，并总结每个患者的相关风险因素和处方；外展访问，提供关于有针对性的处方和使用信息工具的培训的教育；预先支付350英镑(560美元；403欧元)的固定付款，以及在干预12个月内审查的每个患者支付15英镑(24美元；17欧元)的小额付款。我们假设，DQIP干预将减少之前验证的九种高风险处方措施的组合。由于干预的性质，不可能盲目实践、核心研究团队或数据分析师。然而，结果评估是完全客观和自动化的。除主要试验外，还将进行流程和经济评估。讨论：DQIP干预措施是潜在的可持续安全改进干预措施的一个例子，该干预措施建立在现有的国家卫生服务IT基础设施之上，以促进现有执业人员对高风险处方的系统管理。虽然这项试验的重点是非类固醇抗炎药和抗血小板药物，但我们预计，如果被证明有效，测试的干预措施将适用于其他类型的处方。
Background: High-risk prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelet agents accounts for a significant proportion of hospital admissions due to preventable adverse drug events. The recently completed PINCER trial has demonstrated that a one-off pharmacist-led information technology (IT)-based intervention can significantly reduce high-risk prescribing in primary care, but there is evidence that effects decrease over time and employing additional pharmacists to facilitate change may not be sustainable.Methods/design: We will conduct a cluster randomised controlled with a stepped wedge design in 40 volunteer general practices in two Scottish health boards. Eligible practices are those that are using the INPS Vision clinical IT system, and have agreed to have relevant medication-related data to be automatically extracted from their electronic medical records. All practices (clusters) that agree to take part will receive the data-driven quality improvement in primary care (DQIP) intervention, but will be randomised to one of 10 start dates. The DQIP intervention has three components: a web-based informatics tool that provides weekly updated feedback of targeted prescribing at practice level, prompts the review of individual patients affected, and summarises each patient's relevant risk factors and prescribing; an outreach visit providing education on targeted prescribing and training in the use of the informatics tool; and a fixed payment of 350 GBP (560 USD; 403 EUR) up front and a small payment of 15 GBP (24 USD; 17 EUR) for each patient reviewed in the 12 months of the intervention. We hypothesise that the DQIP intervention will reduce a composite of nine previously validated measures of high-risk prescribing. Due to the nature of the intervention, it is not possible to blind practices, the core research team, or the data analyst. However, outcome assessment is entirely objective and automated. There will additionally be a process and economic evaluation alongside the main trial.Discussion: The DQIP intervention is an example of a potentially sustainable safety improvement intervention that builds on the existing National Health Service IT-infrastructure to facilitate systematic management of high-risk prescribing by existing practice staff. Although the focus in this trial is on Non-steroidal anti-inflammatory drugs and antiplatelets, we anticipate that the tested intervention would be generalisable to other types of prescribing if shown to be effective.