Audit and feedback interventions involving pharmacists to influence prescribing behaviour in general practice: a systematic review and meta-analysis

Mary Carter; Nouf Abutheraa; Noah Ivers; Jeremy Grimshaw; Sarah Chapman; Philip Rogers; Michelle Simeoni; Jesmin Antony; Margaret C Watson

doi:10.1093/fampra/cmac150

Audit and feedback interventions involving pharmacists to influence prescribing behaviour in general practice: a systematic review and meta-analysis

Fam Pract. 2023 Dec 22;40(5-6):615-628. doi: 10.1093/fampra/cmac150.

Authors

Mary Carter¹, Nouf Abutheraa², Noah Ivers³, Jeremy Grimshaw⁴, Sarah Chapman¹, Philip Rogers¹, Michelle Simeoni⁵, Jesmin Antony³, Margaret C Watson⁶

Affiliations

¹ Department of Life Sciences, University of Bath, Bath, United Kingdom.
² School of Medicine, University of Aberdeen, Aberdeen, United Kingdom.
³ Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
⁴ Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁵ Public Health Ontario, Toronto, Ontario, Canada.
⁶ Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.

Abstract

Introduction: Pharmacists, as experts in medicines, are increasingly employed in general practices and undertake a range of responsibilities. Audit and feedback (A&F) interventions are effective in achieving behaviour change, including prescribing. The extent of pharmacist involvement in A&F interventions to influence prescribing is unknown. This review aimed to assess the effectiveness of A&F interventions involving pharmacists on prescribing in general practice compared with no A&F/usual care and to describe features of A&F interventions and pharmacist characteristics.

Methods: Electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, (Social) Science Citation Indexes, ISI Web of Science) were searched (2012, 2019, 2020). Cochrane systematic review methods were applied to trial identification, selection, and risk of bias. Results were summarized descriptively and heterogeneity was assessed. A random-effects meta-analysis was conducted where studies were sufficiently homogenous in design and outcome.

Results: Eleven cluster-randomized studies from 9 countries were included. Risk of bias across most domains was low. Interventions focussed on older patients, specific clinical area(s), or specific medications. Meta-analysis of 6 studies showed improved prescribing outcomes (pooled risk ratio: 0.78, 95% confidence interval: 0.64-0.94). Interventions including both verbal and written feedback or computerized decision support for prescribers were more effective. Pharmacists who received study-specific training, provided ongoing support to prescribers or reviewed prescribing for individual patients, contributed to more effective interventions.

Conclusions: A&F interventions involving pharmacists can lead to small improvements in evidence-based prescribing in general practice settings. Future implementation of A&F within general practice should compare different ways of involving pharmacists to determine how to optimize effectiveness.PRISMA-compliant abstract included in Supplementary Material 1.

Keywords: evidence; general practice; pharmacist; prescribing; primary care; systematic review.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Family Practice
Feedback
General Practice*
Humans
Pharmacists*

Grants and funding

University of Bath