Evidence map›Paper›PMID 33413700›Full record

ArticleImplementation science communications2021

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

Sarah L Alderson, Alexander Bald, Paul Carder, Amanda Farrin, Robbie Foy

Abstract read
In one paragraph

Article in Implementation science communications, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Sarah L AldersonLeeds Institute of Health Science, University of Leeds, Leeds, UK. s.l.alderson@leeds.ac.uk.ORCID http://orcid.org/0000-0002-5418-0495
Alexander BaldSchool of Medicine, University of Leeds, Leeds, UK.
Paul CarderWest Yorkshire Research and Development, NHS Bradford District and Craven Clinical Commissioning Group, Bradford, UK.
Amanda FarrinLeeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
Robbie FoyLeeds Institute of Health Science, University of Leeds, Leeds, UK.

Funding

Wellcome Trust ISSF 204825/Z/16/Z
6 · The paper itself

Abstract

backgroundThere is a significant variation among individual primary care providers in prescribing of potentially problematic, low-value medicines which cause avoidable patient harm. Audit and feedback is generally effective at improving prescribing. However, progress has been hindered by research waste, leading to unanswered questions about how to include audit and feedback for specific problems and circumstances. Trials of different ways of providing audit and feedback in implementation laboratories have been proposed as a way of improving population healthcare while generating robust evidence on feedback effects. However, there is limited experience in their design and delivery.

aimTo explore priorities, feasibility, and ethical challenges of establishing a primary care prescribing audit and feedback implementation laboratory. DESIGN AND

settingTwo-stage Delphi consensus process involving primary care pharmacy leads, audit and feedback researchers, and patient and public.

methodParticipants initially scored statements relating to priorities, feasibility, and ethical considerations for an implementation laboratory. These covered current feedback practice, priority topics for feedback, usefulness of feedback in improving prescribing and different types of prescribing data, acceptability and desirability of different organization levels of randomization, options for trial consent, different methods of delivering feedback, and interest in finding out how effective different ways of presenting feedback would be. After receiving collated results, participants then scored the items again. The consensus was defined using the GRADE criteria. The results were analyzed by group and overall score.

resultsFourteen participants reached consensus for 38 out of 55 statements. Addressing antibiotic and opioid prescribing emerged as the highest priorities for action. The panel supported statements around addressing high-priority prescribing issues, taking an "opt-out" approach to practice consent if waiving consent was not permitted, and randomizing at lower rather than higher organizational levels. Participants supported patient-level prescribing data and further research evaluating most of the different feedback methods we presented them with.

conclusionsThere is a good level of support for evaluating a wide range of potential enhancements to improve the effects of feedback on prescribing. The successful design and delivery of a primary care audit and feedback implementation laboratory depend on identifying shared priorities and addressing practical and ethical considerations.

Indexed as

Clinical trialFormative feedbackImplementation scienceInappropriate prescribingPrimary healthcare

Identifiers

PMID33413700
PMCPMC7792204

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.