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Open Access Highly Accessed Study protocol

Prescribing Data in General Practice Demonstration (PDGPD) project - a cluster randomised controlled trial of a quality improvement intervention to achieve better prescribing for chronic heart failure and hypertension

Margaret Williamson1, Magnolia Cardona-Morrell1*, Jeffrey D Elliott2, James F Reeve3, Nigel P Stocks4, Jon Emery5, Judith M Mackson2 and Jane M Gunn6

Author Affiliations

1 Research & Development Team, National Prescribing Service, Level 7, 418a Elizabeth St, Surry Hills, NSW 2012, Australia

2 Program Implementation Team, National Prescribing Service, Level 7, 418a Elizabeth St, Surry Hills, NSW 2012, Australia

3 e-Health and Decision Support Team, National Prescribing Service, Level 6, 176 Wellington Parade, East Melbourne, VIC, 3002, Australia

4 Discipline of General Practice, The University of Adelaide, 178 North Terrace, Adelaide, SA, 5005, Australia

5 Department of General Practice, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia

6 General Practice and Primary Health Care Academic Centre, The University of Melbourne, 200 Berkeley Street, Carlton, VIC, 3053, Australia

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BMC Health Services Research 2012, 12:273  doi:10.1186/1472-6963-12-273

Published: 23 August 2012

Abstract

Background

Research literature consistently documents that scientifically based therapeutic recommendations are not always followed in the hospital or in the primary care setting. Currently, there is evidence that some general practitioners in Australia are not prescribing appropriately for patients diagnosed with 1) hypertension (HT) and 2) chronic heart failure (CHF). The objectives of this study were to improve general practitioner’s drug treatment management of these patients through feedback on their own prescribing and small group discussions with peers and a trained group facilitator. The impact evaluation includes quantitative assessment of prescribing changes at 6, 9, 12 and 18 months after the intervention.

Methods

A pragmatic multi site cluster RCT began recruiting practices in October 2009 to evaluate the effects of a multi-faceted quality improvement (QI) intervention on prescribing practice among Australian general practitioners (GP) in relation to patients with CHF and HT. General practices were recruited nationally through General Practice Networks across Australia. Participating practices were randomly allocated to one of three groups: two groups received the QI intervention (the prescribing indicator feedback reports and small group discussion) with each group undertaking the clinical topics (CHF and HT) in reverse order to the other. The third group was waitlisted to receive the intervention 6 months later and acted as a “control” for the other two groups.

De-identified data on practice, doctor and patient characteristics and their treatment for CHF and HT are extracted at six-monthly intervals before and after the intervention. Post-test comparisons will be conducted between the intervention and control arms using intention to treat analysis and models that account for clustering of practices in a Network and clustering of patients within practices and GPs.

Discussion

This paper describes the study protocol for a project that will contribute to the development of acceptable and sustainable methods to promote QI activities within routine general practice, enhance prescribing practices and improve patient outcomes in the context of CHF and HT. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), Trial # 320870.