A&F: embedding research into practice and practice into research | Third online meeting | November 11th | Time: 15.30-17.15
15.40 – Sarah Alderson and Robbie Foy, University of Leeds, UK
We describe the origins, impacts and lessons learned from two UK audit and feedback research programmes at regional and national levels respectively.
We conducted a cluster-randomised evaluation of an implementation package which targeted four primary care clinical priorities and involved 178 general practices in West Yorkshire. The package included comparative audit and feedback with embedded behaviour change techniques. It was cost-effective in improving care of one of the priorities, high-risk prescribing (especially of non-steroidal anti-inflammatory drugs).
Around the same time, in a different project, we demonstrated a concerning rise in opioid prescribing for patients with non-cancer pain. We therefore collaborated with our local National Health Service Research and Development team to adapt and deliver our audit and feedback intervention to 316 general practices serving a population of 1.9m adults over one year. Our subsequent controlled interrupted time series found that opioid prescribing fell in intervention practices compared to a continuing rise in control practices elsewhere. This reduction corresponded to around 15,000 fewer adults prescribed opioids during the intervention year.
Our feedback intervention has since been adapted to target gabapentinoid and antibiotic prescribing respectively and is now delivered to over 1,000 practices across northern England. We next hope to establish a primary care implementation laboratory, which would randomise practices to different types of feedback to evaluate their relative effectiveness whilst continuing to improve patient care.
We collaborated with UK National Comparative Audit of Blood Transfusions in a programme to develop and evaluate enhanced feedback interventions to increase the appropriateness of blood transfusions. We evaluated the enhanced feedback interventions in two linked factorial cluster-randomized trials, involving 134 and 135 hospitals respectively. Neither enhanced intervention was more effective than standard feedback. However, we identified remediable weaknesses in how the National Comparative Audit of Blood Transfusions was designed. Based on this experience, we went on to collaborate with several other national clinical audit programmes. This latter work included an interview study with researchers, clinical audit programme staff and health care professionals to explore barriers to and enablers of embedding audit and feedback trials within clinical audit programmes. We have since produced a brief guide on embedding trials and on optimising the effects of feedback for national audit programmes.