title: Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS): multicentre, three arm, cluster randomised controlled trial.
abstract: OBJECTIVE
  To evaluate the effectiveness of feedback on safety of prescribing compared with moderately enhanced usual care.
  
  
  METHODS
  Three arm, highly pragmatic cluster randomised trial.
  
  
  METHODS
  262/278 (94%) primary care practices in three Scottish health boards.
  
  
  METHODS
  Practices 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).
  
  
  METHODS
  The 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.
  
  
  RESULTS
  In 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.
  
  
  CONCLUSIONS
  Feedback 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.Trial registration Clinical trials NCT01602705.
authors.affiliation: Population Health Sciences Division, University of Dundee, Dundee DD2 4BF, UK.
authors.forename: Bruce
authors.initials: B
authors.lastname: Guthrie
authors.affiliation: Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Kavanagh
authors.affiliation: Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Robertson
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Barnett
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Shaun
authors.initials: S
authors.lastname: Treweek
authors.affiliation: Centre for Health Policy, University of Melbourne, Melbourne, Australia.
authors.forename: Dennis
authors.initials: D
authors.lastname: Petrie
authors.affiliation: Department of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: Lewis
authors.initials: L
authors.lastname: Ritchie
authors.affiliation: Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK Information Services Division, NHS National Services Scotland, Edinburgh, UK.
authors.forename: Marion
authors.initials: M
authors.lastname: Bennie
mesh_terms: D011307:Drug Prescriptions / Q000592:standards*; D005246:Feedback; D006801:Humans; D061214:Patient Safety; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement; D012107:Research Design; D012606:Scotland