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 | |