Electronic Prescription Data to Improve Primary Care Prescribing

Overview

This is a randomised controlled study to evaluate the effect of providing prescribing feedback that includes individual patient data to General Practitioners (GP) in Scotland on high risk or low quality prescribing.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Health Services Research
    • Masking: None (Open Label)
  • Study Primary Completion Date: January 2017

Detailed Description

This study makes use of data held in the Prescription Information System (PIS), the national database available to national health service (NHS) health boards in Scotland, on all prescriptions dispensed by community pharmacists which include the unique patient identifier for Scotland (CHI). The design is a two parallel arm cluster randomised trial with general practices as the unit of randomisation to whom the feedback intervention is directed, and outcomes measured at patient level. Both arms receive the same active interventions but focused on different topics, with each acting as control to the other. The primary outcome in the asthma arm is a composite of measure of potentially high-risk asthma prescribing (multiple short acting beta-agonists or single agent long acting beta-agonists both in the absence of inhaled corticosteroid therapy). The primary outcome in the urinary tract infection antibiotic arm is a measure of repeated use of single (likely long-term prevention) or multiple (repeated treatment courses) urinary tract infection antibiotics. Within the feedback, alongside the patient-level analysis, there will be action-orientated messages to guide the GP practice. GP practices will get the reports three times at six-monthly intervals.

Interventions

  • Behavioral: Prescription Data Feedback to GP Practices
    • GP practices will be randomly assigned to receive reports on one of the two topics. They will get these three times at six-monthly intervals. Within the feedback, alongside the patient-level analysis, there will be action-orientated messages to guide the GP practice.

Arms, Groups and Cohorts

  • Experimental: Bronchodilators
    • Prescription Data Feedback to GP Practices – practices will be fed back data for people with presumed asthma who have either been dispensed more than 12 short-acting beta-agonist bronchodilators in the last 12 months who are not concurrently prescribed inhaled corticosteroids (poor asthma control with inadequate prevention) or been dispensed a long-acting beta-agonist bronchodilator as a single agent in the last 12 months who are not or are only infrequently concurrently prescribed inhaled corticosteroids (potentially harmful prescribing). To minimise inclusion of people with COPD, patient aged 35 years and older prescribed long-acting antimuscarinic bronchodilators will be excluded. Practices in the bronchodilator arm are controls for the antibiotic experimental arm (below).
  • Experimental: Antibiotics
    • Prescription Data Feedback to GP Practices – number of women in the GP practice aged 12 years and older dispensed more than 6 courses of urinary tract infection (UTI) antibiotics in the last year. UTI antibiotics are defined as trimethoprim, nitrofurantoin, co-trimoxazole, quinolones and cefalexin. Practices in the antibiotic arm are controls for the bronchodilator experimental arm (above).

Clinical Trial Outcome Measures

Primary Measures

  • Number of people identified by the measures of high risk or low quality prescribing
    • Time Frame: 12 months

Secondary Measures

  • Cost-effectiveness of feedback
    • Time Frame: 12 months
    • The economic evaluation will estimate costs and benefits using the cost perspective of the NHS, it will take account medicines cost, costs within the GP practice and use of other NHS services.

Participating in This Clinical Trial

Inclusion Criteria

  • GP practices in the participating Health Board area (NHS Greater Glasgow and Clyde) Exclusion Criteria:

  • GP practices with registered list sizes <250 patients (all of these are unusual practices in various ways, for example serving the homeless or people with challenging behaviour). – GP practices with <80% of prescriptions for inhaled bronchodilators and UTI antibiotics in the prescription database with a recorded patient identifier for each month from January 2014 to December 2014. – GP practices which were created after 1 January 2015.

Gender Eligibility: All

Minimum Age: N/A

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of Dundee
  • Collaborator
    • NHS Greater Glasgow and Clyde
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Sean PD MacBride-Stewart, MSc, Principal Investigator, University of Dundee

Clinical trials entries are delivered from the US National Institutes of Health and are not reviewed separately by this site. Please see the identifier information above for retrieving further details from the government database.

At TrialBulletin.com, we keep tabs on over 200,000 clinical trials in the US and abroad, using medical data supplied directly by the US National Institutes of Health. Please see the About and Contact page for details.