Abstract
BackgroundDigital technologies can enable rapid targeted delivery of audit and feedback interventions at scale. Few studies have evaluated how mode of delivery affects clinical professional behavior change and none have assessed the feasibility of such an initiative at a national scale.ObjectiveThe aim of this study was to develop and evaluate the effect of audit and feedback by digital versus postal (letter) mode of delivery on primary care physician behavior.MethodsThis study was developed as part of the Veterans’ Medicines Advice and Therapeutics Education Services (MATES) program, an intervention funded by the Australian Government Department of Veterans’ Affairs that provides targeted education and patient-specific audit with feedback to Australian general practitioners, as well as educational material to veterans and other health professionals. We performed a cluster randomized controlled trial of a multifaceted intervention to reduce inappropriate gabapentinoid prescription, comparing digital and postal mode of delivery. All veteran patients targeted also received an educational intervention (postal delivery). Efficacy was measured using a linear mixed-effects model as the average number of gabapentinoid prescriptions standardized by defined daily dose (individual level), and number of veterans visiting a psychologist in the 6 and 12 months following the intervention.ResultsThe trial involved 2552 general practitioners in Australia and took place in March 2020. Both intervention groups had a significant reduction in total gabapentinoid prescription by the end of the study period (digital: mean reduction of 11.2%, P=.004; postal: mean reduction of 11.2%, P=.001). We found no difference between digital and postal mode of delivery in reduction of gabapentinoid prescriptions at 12 months (digital: –0.058, postal: –0.058, P=.98). Digital delivery increased initiations to psychologists at 12 months (digital: 3.8%, postal: 2.0%, P=.02).ConclusionsOur digitally delivered professional behavior change intervention was feasible, had comparable effectiveness to the postal intervention with regard to changes in medicine use, and had increased effectiveness with regard to referrals to a psychologist. Given the logistical benefits of digital delivery in nationwide programs, the results encourage exploration of this mode in future interventions.
Highlights
MethodsAudit and feedback interventions can be effective tools to promote evidence translation through professional behavior change [1]
To determine the primary general practitioner HL7 (GP) for a given veteran, we developed an algorithm based on prescriptions and outpatient services provided
189 messages were sent to GPs who had not participated previously
Summary
Audit and feedback interventions can be effective tools to promote evidence translation through professional behavior change [1]. As a cost-effective and data-driven intervention, audit and feedback seems well suited for migrating to a fully electronic mode of delivery [2]. Previous studies of behavior change interventions suggest that the mode of delivery may influence the efficacy of behavior change techniques. Use of different modes of delivery changes users’ experiences by creating new contexts (eg, SMS text message sent at any given time versus scheduled educational sessions), creating more personal experiences (eg, face-to-face group sessions versus social media), and providing new modes of interaction (eg, interactive computer interventions versus printed material). Another review on internet-delivered behavior change interventions found increased efficacy when using additional modes of delivery, such as SMS text messages and email communication [5]. Few studies have evaluated how mode of delivery affects clinical professional behavior change and none have assessed the feasibility of such an initiative at a national scale
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