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 | |