PITCH: Investigating Self review of prescribing by 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. The universal availability of appropriately trained clinical pharmacists is not yet realisable. The concept of a self-review of prescribing (using lessons learned through the pharmacist led REVISIT approach) is therefore being explored. The REVISIT team are working in collaboration with the RCGP Workplace Based Assessment team (WBPA), in order to maximise the utility of the intervention. In common with other postgraduate training bodies, the WBPA have been tasked with providing a meaningful assessment of trainees’ prescribing ability.

Approach

GP AiTs are being recruited into a pilot study, to conduct a self review of sixty sequential prescriptions. The GP AiTs are able to view training materials produced using lessons learned in both the PRACtICe and REVISIT studies. The GP AiT’s trainer will randomly review at least ten of the sixty prescriptions and compare findings. GP AiTs then adopt a reflective learning approach to the errors and suboptimal prescribing that they identify in order to enhance personal prescribing effectiveness. Anonymised prescribing review summary data will be scrutinised by the research team, and semi-structured interviews conducted with up to twenty trainers and trainees. Interviews will be transcribed and analysed for emergent themes.

Findings

GP AiTs are at the stage of being recruited: preliminary findings will able to be presented at the conference in July.

Consequences

Findings from the REVISIT study confirmed that GP AiTs benefited from personalised prescribing review, and reported behaviour change. Structured self review is a pragmatic response to the need for prescribing review in current times. Scrutiny of anonymised prescribing reviews, including comparison with similar reviews previously carried out by a pharmacist (from the REVISIT study), along with the qualitative data collected, will permit preliminary conclusions regarding the feasibility and reliability of self review.