The impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics: a cluster randomised trial
Abstract Background To evaluate the effectiveness of a structured prescription review and prescriber feedback program in reducing prescribing errors in government primary care clinics within an administrative region in Malaysia. Methods This was a three group, pragmatic, cluster randomised trial. In...
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| Format: | Article |
| Language: | English |
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BMC
2018-07-01
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| Series: | BMC Family Practice |
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| Online Access: | http://link.springer.com/article/10.1186/s12875-018-0808-4 |
| _version_ | 1811228178664914944 |
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| author | Wei Yin Lim Amar Singh HSS Li Meng Ng Selva Rani John Jasudass Sondi Sararaks Paranthaman Vengadasalam Lina Hashim Ranjit Kaur Praim Singh |
| author_facet | Wei Yin Lim Amar Singh HSS Li Meng Ng Selva Rani John Jasudass Sondi Sararaks Paranthaman Vengadasalam Lina Hashim Ranjit Kaur Praim Singh |
| author_sort | Wei Yin Lim |
| collection | DOAJ |
| description | Abstract Background To evaluate the effectiveness of a structured prescription review and prescriber feedback program in reducing prescribing errors in government primary care clinics within an administrative region in Malaysia. Methods This was a three group, pragmatic, cluster randomised trial. In phase 1, we randomised 51 clinics to a full intervention group (prescription review and league tables plus authorised feedback letter), a partial intervention group (prescription review and league tables), and a control group (prescription review only). Prescribers in these clinics were the target of our intervention. Prescription reviews were performed by pharmacists; 20 handwritten prescriptions per prescriber were consecutively screened on a random day each month, and errors identified were recorded in a standardised data collection form. Prescribing performance feedback was conducted at the completion of each prescription review cycle. League tables benchmark prescribing errors across clinics and individual prescribers, while the authorised feedback letter detailed prescribing performance based on a rating scale. In phase 2, all clinics received the full intervention. Pharmacists were trained on data collection, and all data were audited by researchers as an implementation fidelity strategy. The primary outcome, percentage of prescriptions with at least one error, was displayed in p-charts to enable group comparison. Results A total of 32,200 prescriptions were reviewed. In the full intervention group, error reduction occurred gradually and was sustained throughout the 8-month study period. The process mean error rate of 40.7% (95% CI 27.4, 29.5%) in phase 1 reduced to 28.4% (95% CI 27.4, 29.5%) in phase 2. In the partial intervention group, error reduction was not well sustained and showed a seasonal pattern with larger process variability. The phase 1 error rate averaging 57.9% (95% CI 56.5, 59.3%) reduced to 44.8% (95% CI 43.3, 46.4%) in phase 2. There was no evidence of improvement in the control group, with phase 1 and phase 2 error rates averaging 41.1% (95% CI 39.6, 42.6%) and 39.3% (95% CI 37.8, 40.9%) respectively. Conclusions The rate of prescribing errors in primary care settings is high, and routine prescriber feedback comprising league tables and a feedback letter can effectively reduce prescribing errors. Trial registration National Medical Research Register: NMRR-12-108-11,289 (5th March 2012). |
| first_indexed | 2024-04-12T09:53:54Z |
| format | Article |
| id | doaj.art-1863c6d4776d4d81bd86f749f796d3e1 |
| institution | Directory Open Access Journal |
| issn | 1471-2296 |
| language | English |
| last_indexed | 2024-04-12T09:53:54Z |
| publishDate | 2018-07-01 |
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| series | BMC Family Practice |
| spelling | doaj.art-1863c6d4776d4d81bd86f749f796d3e12022-12-22T03:37:44ZengBMCBMC Family Practice1471-22962018-07-0119111310.1186/s12875-018-0808-4The impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics: a cluster randomised trialWei Yin Lim0Amar Singh HSS1Li Meng Ng2Selva Rani John Jasudass3Sondi Sararaks4Paranthaman Vengadasalam5Lina Hashim6Ranjit Kaur Praim Singh7Clinical Research Centre Perak, Ministry of Health Malaysia, Level 4, Ambulatory Care Centre, Raja Permaisuri Bainun HospitalClinical Research Centre Perak, Ministry of Health Malaysia, Level 4, Ambulatory Care Centre, Raja Permaisuri Bainun HospitalManjung Health District Office, Ministry of Health MalaysiaSg Chua Health Clinic, Ministry of Health MalaysiaInstitute for Health Systems Research, Ministry of Health MalaysiaJelapang Health Clinic, Ministry of Health MalaysiaClinical Research Centre Perak, Ministry of Health Malaysia, Level 4, Ambulatory Care Centre, Raja Permaisuri Bainun HospitalPerak State Health Department, Ministry of Health MalaysiaAbstract Background To evaluate the effectiveness of a structured prescription review and prescriber feedback program in reducing prescribing errors in government primary care clinics within an administrative region in Malaysia. Methods This was a three group, pragmatic, cluster randomised trial. In phase 1, we randomised 51 clinics to a full intervention group (prescription review and league tables plus authorised feedback letter), a partial intervention group (prescription review and league tables), and a control group (prescription review only). Prescribers in these clinics were the target of our intervention. Prescription reviews were performed by pharmacists; 20 handwritten prescriptions per prescriber were consecutively screened on a random day each month, and errors identified were recorded in a standardised data collection form. Prescribing performance feedback was conducted at the completion of each prescription review cycle. League tables benchmark prescribing errors across clinics and individual prescribers, while the authorised feedback letter detailed prescribing performance based on a rating scale. In phase 2, all clinics received the full intervention. Pharmacists were trained on data collection, and all data were audited by researchers as an implementation fidelity strategy. The primary outcome, percentage of prescriptions with at least one error, was displayed in p-charts to enable group comparison. Results A total of 32,200 prescriptions were reviewed. In the full intervention group, error reduction occurred gradually and was sustained throughout the 8-month study period. The process mean error rate of 40.7% (95% CI 27.4, 29.5%) in phase 1 reduced to 28.4% (95% CI 27.4, 29.5%) in phase 2. In the partial intervention group, error reduction was not well sustained and showed a seasonal pattern with larger process variability. The phase 1 error rate averaging 57.9% (95% CI 56.5, 59.3%) reduced to 44.8% (95% CI 43.3, 46.4%) in phase 2. There was no evidence of improvement in the control group, with phase 1 and phase 2 error rates averaging 41.1% (95% CI 39.6, 42.6%) and 39.3% (95% CI 37.8, 40.9%) respectively. Conclusions The rate of prescribing errors in primary care settings is high, and routine prescriber feedback comprising league tables and a feedback letter can effectively reduce prescribing errors. Trial registration National Medical Research Register: NMRR-12-108-11,289 (5th March 2012).http://link.springer.com/article/10.1186/s12875-018-0808-4Prescribing errorsP-chartStatistical process control chartLeague tablesFeedbackPrescription review |
| spellingShingle | Wei Yin Lim Amar Singh HSS Li Meng Ng Selva Rani John Jasudass Sondi Sararaks Paranthaman Vengadasalam Lina Hashim Ranjit Kaur Praim Singh The impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics: a cluster randomised trial BMC Family Practice Prescribing errors P-chart Statistical process control chart League tables Feedback Prescription review |
| title | The impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics: a cluster randomised trial |
| title_full | The impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics: a cluster randomised trial |
| title_fullStr | The impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics: a cluster randomised trial |
| title_full_unstemmed | The impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics: a cluster randomised trial |
| title_short | The impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics: a cluster randomised trial |
| title_sort | impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics a cluster randomised trial |
| topic | Prescribing errors P-chart Statistical process control chart League tables Feedback Prescription review |
| url | http://link.springer.com/article/10.1186/s12875-018-0808-4 |
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