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Table 2 Recommendations for a primary care prescribing implementation laboratory

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

No. Recommendation A&F researcher’s (n = 5) score (1–9) Medicine optimization lead’s (n = 5) score (1–9) Patient and public involvement and engagement’s (n = 4) score (1–9) % Consensus (n = 14)
Prescribing issues for A&F
 Importance
1. Antibiotic prescribing 9 9 8.5 93
2. Prescribing safety indicators 7 8 7.5 93
3. Opioid medication for chronic, non-cancer pain 9 9 7 86
4. Anticholinergic burden 6 8 7 79
5. Prescribing in low kidney function 8 7 6.5 72
6. Gabapentin and pregabalin painkillers 5 8 6 72
 Priority
7. Antibiotic prescribing 9 9 8.5 100
8. Opioid medication for chronic, non-cancer pain 9 8.5 7.5 93
9. Anticholinergic burden 7.5 7 7 86
10. Prescribing safety indicators 7.5 7 7.5 79
11. Prescribing in low kidney function 7.5 6 6.5 72
  Gabapentin and pregabalin painkillers 6.5 9 8 67
Audit and feedback as a method to improve primary care prescribing
12. Importance 8 8 9 93
13. Usefulness 8 8 7 86
Usefulness of the types of data
14. Subgroups of patients at high risk of dose escalation or adverse effects 8 9 9 100
15. Number of patients taking opioid medication, excluding patients with a palliative care diagnosis 6.5 8 7.5 86
16. Number of patients taking opioid medication, excluding patients taking medication for drug addiction 6 8 8 73
  Specific opioid medications 7 7 7 50
  Number of patients taking opioid medication 5 6 7.5 50
  Total number of opioid prescriptionsa 3 3 3.5 7
Randomization level
17. Randomization at the practice level 9 9 9 100
18. Randomization at the primary care network level 9 9 8 91
19. Randomization at the clinical commissioning group level 8 8 7.5 75
  Randomization at the Sustainability and Transformation Plan level 9 7 8 63
Consent
 Acceptable
20. Provide practices information on the trial and allow them to withdraw from the trial if they wish (practice opt-out) 9 9 9 100
  Consent at the clinical commissioning group level for data access 6 8 7.5 68
  Waive consent as the burden of responding to consent request is higher than taking part in the trial 7 6 8 62
  Consent practices individually, asking them to sign up to an opioid prescribing feedback trial (practice opt-in) 7 5 6.5 36
  Consent at the Sustainability and Transformation Plan level for data access 6 6 6 36
 Ideal
21. Provide practices information on the trial and allow them to withdraw from the trial if they wish (practice opt-out) 8 8 8 86
22. Waive consent as the burden of responding to consent request is higher than taking part in the trial 8 9 8 77
23. Consent at the clinical commissioning group level for data access 7 8 4.5 77
  Consent at the Sustainability and Transformation Plan level for data access 6 7 6.5 64
  Consent practices individually, asking them to sign up to an opioid prescribing feedback trial (practice opt-in) 5 2 5.5 14
Feedback delivery method
 Acceptable
24. Have an online dashboard that practices can log into that connects to the EHR to identify patients where a review is needed 9 9 9 100
  Have an online dashboard that practices can log into to view their report (not linked to the EHR system) 7 7 7.5 64
  Send a PDF copy of the report via email to each practice 6 6 6.5 43
  Provide (multiple) copies of a paper-based report to each practice 6 3 4 21
 Ideal
25. Have an online dashboard that practices can log into that connects to the EHR to identify patients where a review is needed 9 9 9 100
26. Have an online dashboard that practices can log into to view their report (not linked to the EHR system) 8 7 7 79
  Send a PDF copy of the report via email to each practice 5 5 5.5 7
  Provide (multiple) copies of a paper-based report to each practicea 3 1 2.5 2
Feedback modifications to test for effectiveness
27. Whether feedback identifying specific behaviors to be changed is more effective 8 8 7.5 93
28. Whether different comparators within the reports are more effective 8 8 7 86
29. Whether feedback about an individual or aggregated cases is more effective 7 9 7.5 79
30. Whether the frequency or the number of times feedback is delivered affects achievement 6 7 7 79
31. Whether different visual interpretations of the data are more effective 7 9 7.5 71
32. Whether feedback on its own is more (cost-) effective than feedback delivered with educational outreach or training 8 8 7 71
33. Whether different delivery methods of providing feedback are more effective 7 7 8 71
  Whether asking practitioners to document the implications of changing practice is more effective 6 7 5.5 43
Involved in designing feedback reports
34. General practitioners 8 9 9 100
35. Primary care pharmacists 8 8 9 93
36. Medicine optimization leads 8 9 8.5 92
  Clinical commissioners 6 6 7 46
  Patient and public involvement experts 5 6 6 36
  1. Italicized text indicates areas not reaching consensus
  2. aAreas reaching consensus not for inclusion