Postal Feedback Research Articles

The use of postal audit and feedback among Irish General Practitioners for the self \u2013 management of antimicrobial prescribing: a qualitative study

ObjectiveInappropriate use of antibiotics has been acknowledged as a significant contributor to the proliferation of antimicrobial resistance worldwide. Physician prescribing of antibiotics has been identified as a factor in the inappropriate use of antibiotics. One methodology that is used in an attempt to alter physician prescribing behaviours is audit and feedback. This study aimed to explore the perceptions of Irish General Practitioners (GPs) towards the national introduction of postal feedback on their antibiotic prescribing behaviours beginning in 2019.DesignA qualitative descriptive methodology was used. Semi–structured interviews were conducted with GPs in receipt of postal audit and feedback.MethodGPs working in Ireland and in receipt of postal audit and feedback on their antibiotic prescribing behaviours participated in phone-based interviews. The interviews were recorded and transcribed verbatim. The collected data was then analysed using an inductive thematic analysis.ResultsTwelve GPs participated in the study (female = 5). Three themes were identified from the analysis. The themes identified were the reliability and validity of the feedback received, feedback on antibiotic prescribing is useful but limited and feedback needs to be easily digestible.ConclusionWhile the postal audit and feedback were broadly welcomed by the participants, the themes identified a perceived limitation in the quality of the feedback data, the perception of a likely low public health impact of the feedback and difficulties with efficiently processing the audit and feedback information. These findings can help refine future audit and feedback interventions on antibiotic prescribing.

Introduction of Transnasal Endoscopy to a Scottish District General Hospital.

Esophagogastroduodenoscopy can be uncomfortable and distressing with many patients opting for conscious sedation over topical local anesthetic spray. Transnasal endoscopy is an alternative and we sought to assess how easily it could be introduced to a district general hospital and how acceptable patients found it. Selected patients requiring diagnostic endoscopy were offered transnasal endoscopy with topical nasal anesthetic by clinicians new to transnasal endoscopy but competent at esophagogastroduodenoscopy. Postal feedback questionnaires were used to assess comfort, distress, recollection of periprocedural consultation, and overall experience (visual analog scale 1-10). A total of 213 transnasal endoscopy procedures were undertaken with 207 completed successfully (97.2%). Two patients (0.9%) had self-limiting epistaxis and no patient required admission. One hundred (47%) questionnaires were returned including 98 from those with completed transnasal endoscopy. Thirty-three (33%) had previous esophagogastroduodenoscopy and 28 (85%) reported a preference for transnasal endoscopy. Fifty-eight patients (59%) found transnasal endoscopy comfortable (visual analog scale >6) with 17 reporting discomfort (visual analog scale <5). Seventeen patients found the procedure distressing (visual analog scale >6) but 70 (73%) did not (visual analog scale <5). Eighty-four patients (85.7%) had clear recollection of their procedure (visual analog scale >6) and overall satisfaction was reported as good (visual analog scale >6) by 94.7%. Transnasal endoscopy can be adopted by clinicians competent with conventional esophagogastroduodenoscopy with expectation of high procedure completion rate and low complication rate. Our patients reported high levels of satisfaction with few reporting distress. Perhaps as a consequence, most patients had a clear recollection of their procedure.

Developing an intervention to prevent acute kidney injury: using the Plan, Do, Study, Act (PDSA) service improvement approach.

In the UK, recent National Institute for Health and Care Excellence guidelines for acute kidney injury point to the need for interventions to help prevent this condition. Effective medicines management is of prime importance in reducing the risk of AKI. Part of this challenge is to increase patients' awareness of their medicines and the possible need to temporarily withhold certain medications when acutely unwell. The objectives were to use a service improvement approach (the Plan, Do, Study, Act cycle) to develop an intervention and to evaluate current delivery of acute kidney injury management and to test and generate new ideas relating to patients' needs. A postal feedback form sent to a random sample of over 200 patients with chronic kidney disease. The feedback form collected information on: what patients know about acute kidney injury and managing medicines; where patients get their information from; whether patients want more information and where from; and what patients feel about self-managing their medicines. Completed feedback forms were received from 113 participants. Of these, 92% said they had received no advice, 77% of respondents wanted more advice but only 17% said they would feel comfortable to stop their own medication without medical consent. The PDSA cycle offered a very useful framework to evaluate the current service delivery and to test and generate new ideas for the development of an AKI intervention. Our findings highlighted that the current service is limited and more robust research is needed.

General practitioners' awareness of their own drug prescribing profiles after postal feedback and outreach visits

Background. General practice accounts for the vast majority of drug prescribing in the Nordic countries. Various methods have been used to promote rational drug prescribing. Awareness of own prescribing profile may be a first crucial step in the quality assessment and improvement process.Aim of the study. To analyse awareness among general practitioners of their drug prescribing profile during two outreach visits one year apart.Methods. All 94 practices with a total of 166 general practitioners in the former Storstrøm County, Denmark, were invited to participate in a project launching outreach visits led by a general practitioner; 88 practices with 160 general practitioners agreed to participate.Results. During the first round of outreach visits the general practitioners were asked to rate their own prescribing level of 13 major drug groups as being in the lowest 25%, the middle 26%–74%, or the highest 25% of the distribution across all 88 practices. The result was better than chance (chi-square = 337, 4 df, r = 0.37, both P < 0.0001). After the assessment a one-hour discussion on rational drug prescribing was held. One year later a new round of outreach visits was held. This time the assessment accuracy was generally greatly improved (chi-square = 724, 4 df, r = 0.48, both P < 0.0001). The main determinants for the improved accuracy during the second round were high accuracy during the first round, and the number of general practitioners in the practice.Conclusions. General practitioners' awareness of their prescribing volumes was substantially improved by a single outreach visit with discussion on rational drug prescribing.

The cost-effectiveness of tailored, postal feedback on general practitioners’ prescribing of pharmacotherapies for alcohol dependence

AimsThe aims of this study were to conduct a randomised controlled trial to evaluate the cost-effectiveness of tailored, postal feedback on general practitioners’ (GPs) prescribing of acamprosate and naltrexone for alcohol dependence relative to current practice and its impact on alcohol dependence morbidity. MethodsRural communities in New South Wales, Australia, were randomised into experimental (N=10) and control (N=10) communities. Tailored feedback on their prescribing of alcohol pharmacotherapies was mailed to GPs from the experimental communities (N=115). Segmented regression analysis was used to examine within and between group changes in prescribing and alcohol dependence hospitalisation rates compared to the control communities. Incremental cost-effectiveness ratios (ICERs) were estimated per additional prescription of pharmacotherapies and per alcohol dependence hospitalisation(s) averted. ResultsPost-intervention changes, relative to the control communities, in GPs’ prescribing rate trends in the experimental communities significantly increased for acamprosate (β=0.24, 95% CI: 0.13–0.35, p<0.001), and significantly decreased for naltrexone (β=−0.12, 95% CI: −0.17 to −0.06) per quarter. Quarterly hospitalisation trend rates for alcohol dependence, as principal diagnosis, significantly decreased (β=−0.07, 95% CI: −0.13 to −0.01, p<0.05), compared to control communities. The median ICER per quarterly hospitalisation(s) averted due to intervention was Dominant (Dominant – $12,750). ConclusionPostal, tailored feedback to GPs on their prescribing of acamprosate and naltrexone for alcohol dependence was a cost-effective intervention, in rural communities of NSW, to increase the overall prescribing of pharmacotherapies with a plausible effect on incidence reduction of hospitalisations for alcohol dependence as principal diagnosis.

Review: Acamprosate increases abstinence in patients with alcohol dependence

ACP Journal Club18 January 2011Review: Acamprosate increases abstinence in patients with alcohol dependenceJennifer McNeely, MD, MS, Scott Sherman, MD, MPHJennifer McNeely, MD, MSNew York University School of Medicine, New York, New York, USA (J.M., S.S.)Search for more papers by this author, Scott Sherman, MD, MPHNew York University School of Medicine, New York, New York, USA (J.M., S.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-2-201101180-02010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationRösner S, Hackl-Herrwerth A, Leucht S, et al. Acamprosate for alcohol dependence. Cochrane Database Syst Rev. 2010;(9):CD004332. https://pubmed.ncbi.nlm.nih.gov/20824837Clinical Impact RatingsGIM/FP/GP: Mental Health: References1 Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238-45. [PMID: 15010446] Google Scholar2 Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Results from the 2007 National Survey on Drug Use and Health: national findings. 2008. www.oas.samhsa.gov/NSDUH/2k7NSDUH/2k7results.cfm#Ch7 (accessed 25 Nov 2010). Google Scholar3 Anton RF, O’Malley SS, Ciraulo DA, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA 2006;295:2003-17. [PMID: 16670409] Google Scholar4 Mason BJ, Goodman AM, Chabac S, Lehert P. Effect of oral acamprosate on abstinence in patients with alcohol dependence in a double-blind, placebo-controlled trial: the role of patient motivation. J Psychiatr Res. 2006;40:383-93. [PMID: 16546214] Google Scholar Author, Article, and Disclosure InformationAuthors: Jennifer McNeely, MD, MS; Scott Sherman, MD, MPHAffiliations: New York University School of Medicine, New York, New York, USA (J.M., S.S.)This article was published at Annals.org on 4 January 2011. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe cost-effectiveness of tailored, postal feedback on general practitioners’ prescribing of pharmacotherapies for alcohol dependenceBaclofen has opposite effects on escalation of cocaine self-administration: Increased intake in rats selectively bred for high (HiS) saccharin intake and decreased intake in those selected for low (LoS) saccharin intake 18 January 2011Volume 154, Issue 2Page: JC1-10KeywordsAlcoholismDiarrheaDrug dependenceDrugsNumber needed to harmNumber needed to treatOutpatientsPatientsPsychiatry and mental healthRelative risk ePublished: 18 January 2011 Issue Published: 18 January 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Cervicomastoidfacial versus modified facelift incision for parotid surgery: a patient feedback comparison

Traditionally, the cervicomastoidfacial (CMF) incision is used to excise benign tumours of the parotid gland. The rhytidectomy or modified facelift (MF) incision allows an alternative approach which leaves no visible neck scar. The objective of this study was to establish the frequency of each surgical approach used and identify any difference in complication and patient satisfaction between the two incisions for benign conditions of the parotid gland. A retrospective analysis of 101 case notes for patients who underwent parotidectomy by both ENT and maxillofacial departments between January 2006 and February 2008 was undertaken. All histologically confirmed cases of malignancy were excluded. For each incision, immediate postoperative complications were obtained from the notes. A postal patient outcome evaluation questionnaire sought information regarding persistent and late complications as well as a visual analogue scar satisfaction score for both incisions. Overall, 79 parotidectomies were included (59 CMF incisions, 20 MF incisions). Of CMF incisions, 34% suffered facial weakness immediately postoperatively versus 20% of MF incisions. Of CMF incisions, 4% suffered postoperative haematomas versus none following MF incisions. In the study cohort, 47 (60%) responded to the postal feedback questionnaire (33 CMF versus 14 MF respondents). Information regarding immediate and late postoperative ipsilateral facial paraesthesia and gustatory sweating was obtained. Mean visual analogue scar satisfaction scores were 9.4 for CMF incisions and 8.9 for MF incisions. Immediate and late complications for CMF and MF approaches for benign disease parotidectomy were comparable, but scar satisfaction following MF incision was not greater than CMF incisions.

A comparison of two consensus methods for classifying morbidities in a single professional group showed the same outcomes

Objective To investigate whether consensus differs when reached by the Nominal or the Delphi method. Study Design and Setting Seventeen general practices from North Staffordshire, England were randomly allocated to Delphi (postal feedback only) or Nominal group (also had group discussion). General practitioners classified 56 morbidities according to four scales of severity (chronicity, time course, health care use, patient impact) in two consensus rounds. Consensus outcomes were assessed by between-group comparison of severity scores at baseline and follow-up rounds, and consensus process by within-group change in the variance of severity scores between the two rounds. Results Consensus rounds were completed by 21 out of 35 Nominal GPs and 23 out of 43 Delphi GPs. Baseline scores for three of the four severity scales were significantly higher for Nominal compared to Delphi GPs, but there were no differences at follow-up. Between the two rounds, variance reduced within the Nominal and Delphi group, respectively, by 61% and 35% (chronicity), 40% and 62% (time course), 42% and 36% (health care use), and 19% and 38% (patient impact). Conclusion The Nominal and Delphi methods did not result in different outcomes and we conclude that either method can be used in health services research.

Mailed prescriber feedback in addition to a clinical guideline has no impact: a randomised, controlled trial

Scand J Prim Health Sci 2002;20:000-000. ISSN 0281-3432 Objective - To evaluate the impact of feedback on the prescribing of antibiotics supplementary to clinical guidelines in the treatment of respiratory tract infections. Design - Randomised, controlled trial with GPs allocated to one of two groups. The first group received clinical guidelines on the treatment of respiratory tract infections plus postal feedback with aggregated data on their prescribing patterns for antibiotics. The second group served as controls for the first group and received the guidelines only. Setting - 299 GPs representing 181 practices with 455 843 listed patients in the County of Funen, Denmark. Main outcome measures - Effects on GP prescribing patterns were measured by means of a prescription database and followed for a period of 2 years with 2 outcome measures: 1) the antibiotic prescription rate and 2) the fraction of prescriptions for narrow-spectrum antibiotics. Results - The addition of feedback had no impact on GP prescribing patterns. Conclusion - Postal disseminated prescriber feedback in addition to a clinical guideline on the diagnosis and treatment of respiratory tract infections does not influence GP prescribing patterns. Interventions aimed at improving performance in general practice should go beyond just giving GPs information on whether they are living up to standards.

Original Paper: The management of Helicobacter pylori infection in primary care Guidelines from the ESPCG

Objective: There have been numerous national and international attempts to define the management of H. pylori infection, largely characterised by a consensus approach and a predominantly specialist perspective. Most patients with H. pylori infection are managed in primary care where the approach is patient centred and often symptom based. The aim of this project was to develop evidence-based guidelines that were relevant and valid for general practitioners (GPs) across all of Europe.Method: A consensus meeting of 48 GPs from nine European countries identified key issues through the structured consideration in small groups of a series of case scenarios. The process was supported by access to national prevalence data, key research literature and on-line databases. It featured an immediate and a later postal feedback round. Consensus scores were calculated for each decision point, together with a rating of the supporting evidence. The output was combined with a systematic review of the literature.Results: The key guidance points are as follows: 1) Eradication therapy should be considered for patients who consult with recurrent dyspepsia, those with newly diagnosed peptic ulcer disease (PUD), and those with a previous diagnosis of PUD whose symptoms relapse or who require long-term acid suppression therapy. 2) Carbon-13 urea breath test (CUBT) or endoscopy and biopsy are the recommended diagnostic tests for H. pylori infection. CUBT is the most useful test for successful eradication. 3) The recommended eradication therapy is a standard dose of proton pump inhibitor, clarithromycin 500 mg and amoxycillin 1000 mg, all twice daily for seven days. 4) An awareness of local resistance rates for metronidazole and clarithromycin is essential for effective treatment.