Educational interventions delivered to prescribing advisers to influence primary care prescribing: a very low-cost pragmatic randomised trial using routine data from OpenPrescribing.net

TL;DR

A low-cost trial tested if educational sessions for healthcare advisors could reduce low-priority prescriptions in primary care, but found no significant effect.

Contribution

Demonstrates a low-cost method for evaluating the effectiveness of routine healthcare guidance interventions using real-world data.

Findings

The educational intervention did not significantly reduce primary care prescribing of low-priority items.

There was some evidence of increased engagement with data, such as more email alert sign-ups.

No harmful effects of the intervention were detected.

Abstract

NHS England issued commissioning guidance on 18 low-priority treatments which should not be routinely prescribed in primary care. We aimed to monitor the impact of an educational intervention delivered to regional prescribing advisors by senior pharmacists from NHS England on the primary care spend on low-priority items.

An opportunistic randomised, controlled parallel-group trial. Participants (clinical commissioning groups, CCGs) were randomised to intervention or control in a 1:1 ratio. The intervention group were invited to participate. The intervention was a one-off educational session. Our primary outcomes concerned the total prescribing of low-priority items in primary care. Secondary outcomes concerned the prescribing of specific low-priority items. We also measured the impact on information-seeking behaviour.

40 CCGs were randomised, 20 allocated to intervention, with 11 receiving the intervention. There was no significant impact on any prescribing outcomes. There was some possible evidence of increased engagement with data, in the form of CCG email alert sign-ups (p = 0.077). No harms were detected.

A one-off intervention delivered to CCGs by NHS England did not significantly influence low-priority prescribing. This trial demonstrates how routine interventions planned to improve uptake or adherence to healthcare guidance can be delivered as low-cost randomised trials and how to robustly assess their effectiveness.

ISRCTN31218900, October 01 2018.

The online version contains supplementary material available at 10.1186/s12913-024-11575-y.

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