Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS): multicentre, three arm, cluster randomised controlled trial
Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS): multicentre, three arm, cluster randomised controlled trial
复制标题
DOI：
10.1136/bmj.i4079
复制
发表时间：
2016-08-18
影响因子：
105.7
通讯作者：
Bennie, Marion
中科院分区：
文献类型：
--
作者：
Guthrie, Bruce;Kavanagh, Kimberley;Bennie, Marion
ACTERIVETo evaluate effectiveness of feedback on safety of prescribing compared with moderate enhanced usual care.DesignThree arm，highly pragmatic cluster randomized trial.Settingand participants 262/278（94%）primary care practices in three Scottish health boards. Interventions Practices were randomized to：“常规护理”，包括通过电子邮件发送的教育材料，支持搜索以识别患者（基线时88个实践，分析了86个）;常规护理加上对实践高风险处方的反馈，每季度发送5次（87项做法，86项已分析）;或常规护理加上包含行为改变成分的相同反馈（87个实践，分析了86个）。主要结果测量主要结果是与抗精神病药，非甾体抗炎药，和抗血小板药。次要结局是6项单独指标。主要分析比较了15个月时两个反馈组中的高风险处方与常规护理。二次分析检查了即时变化和变化的趋势，高风险处方与实施的干预措施，在每个arm.ResultsIn主要分析，高风险处方作为衡量的主要成果下降，从6.0%，（3 332/55 896）至5.1%（2845/55872）在常规护理组中，与5.9%相比，（3 341/56 194）至4.6%（2587/56 478）仅反馈臂（与常规护理相比，优势比为0.88（95%置信区间为0.80至0.96）; P=0.007）和反馈加行为改变组件组的6.2%（3634/58 569）至4.6%（2686/58 582）（0.86（0.78至0.95）; P=0.002）。在预先规定的各组内趋势变化的次要分析中，常规护理教育干预对高风险处方的现有下降趋势没有影响。这两种类型的反馈都与显着更快速下降的高风险处方干预后相比before.ConclusionsFeedback处方安全数据是有效的，减少高风险处方。在普遍使用电子健康记录的情况下，这种干预措施是可行的。
OBJECTIVETo evaluate the effectiveness of feedback on safety of prescribing compared with moderately enhanced usual care.DesignThree arm, highly pragmatic cluster randomised trial.Settingand participants 262/278 (94%) primary care practices in three Scottish health boards.InterventionsPractices were randomised to: "usual care," consisting of emailed educational material with support for searching to identify patients (88 practices at baseline, 86 analysed); usual care plus feedback on practice's high risk prescribing sent quarterly on five occasions (87 practices, 86 analysed); or usual care plus the same feedback incorporating a behavioural change component (87 practices, 86 analysed).Main outcome measuresThe primary outcome was a patient level composite of six prescribing measures relating to high risk use of antipsychotics, non-steroidal anti-inflammatories, and antiplatelets. Secondary outcomes were the six individual measures. The primary analysis compared high risk prescribing in the two feedback arms against usual care at 15 months. Secondary analyses examined immediate change and change in trend of high risk prescribing associated with implementation of the intervention within each arm.ResultsIn the primary analysis, high risk prescribing as measured by the primary outcome fell from 6.0% (3332/55 896) to 5.1% (2845/55 872) in the usual care arm, compared with 5.9% (3341/56 194) to 4.6% (2587/56 478) in the feedback only arm (odds ratio 0.88 (95% confidence interval 0.80 to 0.96) compared with usual care; P=0.007) and 6.2% (3634/58 569) to 4.6% (2686/58 582) in the feedback plus behavioural change component arm (0.86 (0.78 to 0.95); P=0.002). In the pre-specified secondary analysis of change in trend within each arm, the usual care educational intervention had no effect on the existing declining trend in high risk prescribing. Both types of feedback were associated with significantly more rapid decline in high risk prescribing after the intervention compared with before.ConclusionsFeedback of prescribing safety data was effective at reducing high risk prescribing. The intervention would be feasible to implement at scale in contexts where electronic health records are in general use.