Pharmacist and Data-driven Quality Improvement in Primary Care (P-DQIP): Implementation of an informatics tool to support polypharmacy reviews by pharmacists

What we know

Preventable drug related harm accounts for 4% of emergency hospital admissions, of which two thirds could be prevented by better systems for managing patients with risky prescribing.

The DQIP1 trial has demonstrated that an informatics tool that remotely identifies patients with high-risk prescribing of antiplatelets and non-steroidal anti-inflammatory drugs (NSAIDs) from general practices’ electronic medical records combined with education and financial incentives can reduce such prescribing and related emergency admissions (Dreischulte et al., 2012). The overall aim of the P-DQIP programme is to expand the scope of the DQIP informatics tool to include patients with risky polypharmacy and make the intervention sustainable by involving NHS employed already affiliated pharmacists in the review process. The key behaviour targeted is the pro-active identification and management of patients identified to be at an increased risk of adverse drug events.

                                             Figure 1: Intended process for pharmacist-led medication review as part of the P-DQIP intervention (in black) and implementation processes (in blue).  (DTR = Drug Therapy Risk). 

Project aim

To identify anticipated barriers and facilitators to P-DQIP implementation from the perspective of practice pharmacists, with a view to optimising planned intervention components and/or designing additional components to support implementation by pharmacists.

What this research explored?

Semi-structured interviews with an NHS Tayside sample of 14 employed practice pharmacists aiming for heterogeneity in terms of current working location and working experience. Interviews were transcribed verbatim and analysed initially using thematic analysis and subsequently using the TDF. The TDF consists of 14 domains (Cane, O’Connor & Michie, 2012), i.e. potential determinants of behaviour, and has been extensively used to identify the potential influences on health care professional behaviour (Michie, Atkins, & West, 2014).

What this study adds

Most participating pharmacists had over 5 years’ experience as practice pharmacists (11 of 14; 79%) and worked in 2 or more practices. Findings were arranged into 14 TDF domains, which have been demonstrated to be useful in understanding how to change behaviour. Relevant theoretical domains were identified under three categories. These were (1) Applying clinical expertise: knowledge and skills; beliefs about capabilities; memory/attention/decision process, (2) Collaborating and communicating with others: skills; professional/social role and identity; emotion; social influences, and (3) Engaging in and organising the workload: environmental context and resources; professional/social role and identity; beliefs about consequences; behavioural regulation.

Benefits and impact

Highlighted from this study was:

• The perceived high work load from routine tasks such as cost-saving work, medicines reconciliation after discharge and referrals from others, was exacerbated by staff shortages.
• Protected time, was highlighted as a key element required to pro-actively manage a case load of patients identified to be at increased risk of drug related harm.
• Several participants emphasised that facilitation of identification and review of patients via an informatics tool has the potential to save time, provided that it is easy to set up and straightforward to use.

Collaborators

The project was led by Dr Jason Tang, supported by colleagues from the School of Health Sciences, School of Medicine and Health Informatics Centre at the University of Dundee, working alongside primary care colleagues across NHS Tayside.      

For more information please contact SISCC  (siscc@dundee.ac.uk)   

Related Publications:

Pharmacist and Data-Driven Quality Improvement in Primary Care (P-DQIP): a qualitative study of anticipated implementation factors informed by the Theoretical Domains Framework (2020)

Safer Prescribing – A Trial of Education, Informatics, and Financial Incentives (2016)  

Summary of the DQIP2 project (2011)

Links:

Scottish Patient Safety Programme – Medicines