Background
Methods
Trial design
Research outcomes
Intervention components
Target behaviours
Elicitation study (focus groups)
Email Delphi questionnaire study
Mapping targeted variables to behaviour change techniques
Psychology construct | Level of evidence based on expert opinion (Michie[17]) | |
---|---|---|
Agreed use | Uncertain | |
Attitude (beliefs about consequences) | •Self-monitoring | •Monitoring
|
•Persuasive communication
| •Graded task | |
•Information regarding behaviour/outcome
| •Modelling/demonstration of behaviour
| |
•Feedback
| ||
Subjective norms (social influences) | •Social processes of encouragement, pressure, support
| •Monitoring
|
•Modelling/demonstration of behaviours
|
Reward/incentives
| |
•Role play | ||
•Persuasive communication | ||
•Homework | ||
Perceived behavioural control (beliefs about capabilities and environmental context and resources) | •Self-Monitoring | •Monitoring
|
•Graded task
| •Reward/incentives
| |
•Increasing skills, problem solving, goal setting
| •Stress management | |
•Coping skills | •Information regarding behaviour/outcome
| |
•Rehearsal of relevant skills | •Personalised message | |
•Social processes of encouragement
| ||
•Feedback
| ||
•Self-talk | ||
•Environmental changes, e.g. objects to facilitate behaviour
| ||
Action planning (action planning) | •Goal target specified
| •Monitoring
|
•Contract | •Social processes of encouragement | |
•Planning/implementation
| •Personalised message | |
•Prompts, triggers, cues
| •Homework | |
•Use of imagery | •Feedback
| |
•Self-talk |
Results
Research outcomes
Prescribing indicators | |
---|---|
1. | Oral antipsychotic prescription to a patient aged 75 years and over (as a proxy of oral antipsychotic prescribing to older people with dementia). |
2. | Oral non-steroidal anti-inflammatory drug (NSAID) prescription to a patient aged 65 years and over who is currently prescribed a diuretic and an ACE inhibitor or angiotensin receptor blocker (the `triple whammy’). |
3. | Oral NSAID prescription to a patient aged 75 years and over but who is not currently prescribed a gastroprotective drug. |
4. | Oral NSAID prescription to a patient aged 65 years and over who is currently prescribed either aspirin or clopidogrel but who is not currently prescribed a gastroprotective drug. |
5. | Oral NSAID prescription to a patient currently prescribed an oral anticoagulant but who is not currently prescribed a gastroprotective drug. |
6. | Aspirin or clopidogrel prescription to a patient currently prescribed an oral anticoagulant but who is not currently prescribed a gastroprotective drug. |
Intervention components
Elicitation study (focus groups)
Email Delphi questionnaire study
TPB constructs | Delphi questionnaire: results |
---|---|
Attitude |
Consensus of agreement regarding ATTITUDES toward responding to prescribing feedback (≥75% agree/strongly agree; ≥6 GPs were outliers)
|
Reviewing patient prescribing was a positive thing to do for the patient. | |
Reviewing patient prescribing gave GPs a sense of protecting their patients. | |
The fear of a patient having a significant event as a result of receiving high-risk prescribing caused GPs concern. | |
Reviewing patient prescribing was important. | |
GPs do not regard receiving prescribing feedback as a criticism. | |
GPs would not feel defensive in response to receiving prescribing feedback. | |
There was disagreement among GP responses to the following statements (>25%; more than 6 GPs were outliers)
| |
Being seen by my colleagues to have unwittingly prescribed a high-risk drug would be embarrassing. | |
A negative event as a result of changing prescribing in the past would make me less likely to change or stop medications in the future. | |
Subjective norms |
Consensus of agreement regarding the importance of other groups and the importance of their opinions to GPs (≥75% agree/strongly agree)
|
The groups of people most likely to approve of responding to prescribing feedback were the GMC, other GPs and practice pharmacists. | |
Approval from patients and GPs within their own practice was most important, followed by approval from the GMC then the practice pharmacist. | |
Perceived Behavioural Control (PCB) |
Consensus of agreement regarding the BARRIERS to respond to the prescribing feedback (≥75% agree/strongly agree)
|
GPs would be less likely to respond to the prescribing feedback if clinical guidelines are unclear, or there is no sound evidence base. | |
A negative event as a result of changing prescribing in the past would make GPs less likely to change or stop patient’s medication in the future. | |
There was disagreement among GP responses to the following statements (>25%)
| |
I already have too much to do and would struggle to find time to review patients receiving high-risk prescribing. | |
I will not respond to the prescribing feedback if it appears difficult, or it is not clear what I need to do. | |
Even when it is high risk, I find it difficult to change my patients prescribing when they feel fine and are having little or no side effects from their medication. | |
I find stopping medications more difficult if the medication was started in secondary care. | |
Patient preferences are a key determinant for me when considering whether or not to change a patient’s medication. | |
Consensus of agreement regarding FACILITATORS of responding to the prescribing feedback (≥75% agree/strongly agree)
| |
Prescribing feedback is more persuasive if the recommendations are in line with SIGN/NICE guidelines. | |
The messenger is important, and GPs would be more likely to respond to the prescribing feedback that came from the practice pharmacist, a respected clinician or the Health Board. | |
GPs would be more likely to respond to the prescribing feedback knowing that they would be able to benchmark the performance of their practice against other practices. | |
GPs would be more likely to respond to the prescribing feedback if they could use the reviews as part of their annual appraisal. |