Strategies supporting sustainable prescribing safety improvement interventions in english primary care: qualitative study

BACKGROUND: Whilst the use of prescribing safety indicators (PSI) can reduce potentially hazardous prescribing, there is a need to identify actionable strategies for the successful implementation and sustainable delivery of PSI-based interventions in general practice.

AIM: To identify strategies for the successful implementation and sustainable use of PSI-based interventions in routine primary care.

DESIGN & SETTING: Qualitative study in primary care settings across England.

METHOD: Anchoring on a complex pharmacist-led IT-based intervention (PINCER) and clinical decision support (CDS) for prescribing and medicines management, we conducted a qualitative study using sequential, multiple methods which comprised of documentary analysis, semi-structured interviews and online workshops to identify challenges and possible solutions to the longer-term sustainability of PINCER and CDS. Thematic analysis was used for the documentary analysis and stakeholder workshops, whilst template analysis was used for the semi-structured interviews. Findings across the three methods were synthesised using the RE-AIM framework.

RESULTS: We analysed 48 documents, undertook 27 interviews and two workshops involving 20 participants. Five main issues were identified, which aligned with the adoption and maintenance dimensions of RE-AIM: fitting into current context (adoption); engaging hearts and minds (maintenance); building resilience (maintenance); achieving engagement with secondary care (maintenance); and emphasising complementarity (maintenance).

CONCLUSIONS: Extending ownership of prescribing safety beyond primary care-based pharmacists and achieving greater alignment between general practice and hospital prescribing safety initiatives is fundamental to achieve sustained impact of PSI-based interventions in primary care.