REVISIT, the next stage – developing plans for wider application of a retrospective review of prescribing of GPs in Training

Problem

The GMC PRACtICe study identified prescribing errors in general practice occurring at a rate of about 5%. GPs in training (GP AiTs) were highlighted as a group who may benefit from further help to reduce their prescribing errors. A recent pilot study explored the effect of reviewing 100 sequential prescriptions issued by ten GPs AiTs. The error rate in this small cohort (making up the REVISIT study) was found to be nearly double that reported in the PRACtICe study (9%). There was a high rate of ‘suboptimal prescribing’ (35%), which included aspects of poor practice such as providing incomplete information on a prescription. Further analysis of the data showed that certain drugs (such as morphine) were associated with a prescribing error each time a prescription for that drug was made. Three month follow up interviews with the GP AiTs and their trainers provided useful insight into prescribing behaviour and rationale for behaviour change.Although having face validity, the REVISIT process was costly in terms of pharmacist time. We wanted to ascertain if there would be the potential for targeted or widespread adoption of the REVISIT process as it stands, if modification of the process would be needed, or if a larger scale intervention trail would be beneficial.

Approach

Interviews and focus groups with at least 20 stakeholders or stakeholder organisations are being performed during which results from the REVISIT study are presented, and plans for development explored. Stakeholders include organisations involved with training and regulating GPs and pharmacists, as well as other interested parties such as GP AiTs and members of the public. Focus groups and interviewed are being audio-recorded, professionally transcribed and then analysed for emergent themes using a constant comparative approach.

Findings

Interviews are scheduled to take place between February and April. Preliminary findings continue to be supportive of the concept of GPs in training receiving a personalised review of prescribing. The feasibility of a universal roll out which involves review by a specially trained pharmacist has been questioned. Alternatives have been presented, which include peer review and self-review. The opportunistic involvement of practice pharmacists is a theme that continues to be explored, especially where mutual benefit may be gained by both GP in training and pharmacist (who may also be able to receive some form of review from the GP in training).

Consequences

Findings from the REVISIT study confirmed that GP AiTs benefited from personalised prescribing review, and reported behaviour change. By conducing systematic stakeholder interviews we aim to elucidate whether a larger intervention study is required, or whether the REVISIT process can be implemented universally or in a targeted or amended format.