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Randomized Controlled Trial
. 2022 Jan 10;24(1):e33873.
doi: 10.2196/33873.

Implementation and Evaluation of a Digitally Enabled Precision Public Health Intervention to Reduce Inappropriate Gabapentinoid Prescription: Cluster Randomized Controlled Trial

Andre Q Andrade  1 , Jean-Pierre Calabretto  1   2 , Nicole L Pratt  1 , Lisa M Kalisch-Ellett  1 , Gizat M Kassie  1 , Vanessa T LeBlanc  1 , Emmae Ramsay  1 , Elizabeth E Roughead  1
Affiliations
Randomized Controlled Trial

Implementation and Evaluation of a Digitally Enabled Precision Public Health Intervention to Reduce Inappropriate Gabapentinoid Prescription: Cluster Randomized Controlled Trial

Andre Q Andrade et al. J Med Internet Res. .

Expression of concern in

Abstract

Background: Digital technologies can enable rapid targeted delivery of audit and feedback interventions at scale. Few studies have evaluated how mode of delivery affects clinical professional behavior change and none have assessed the feasibility of such an initiative at a national scale.

Objective: The aim of this study was to develop and evaluate the effect of audit and feedback by digital versus postal (letter) mode of delivery on primary care physician behavior.

Methods: This study was developed as part of the Veterans' Medicines Advice and Therapeutics Education Services (MATES) program, an intervention funded by the Australian Government Department of Veterans' Affairs that provides targeted education and patient-specific audit with feedback to Australian general practitioners, as well as educational material to veterans and other health professionals. We performed a cluster randomized controlled trial of a multifaceted intervention to reduce inappropriate gabapentinoid prescription, comparing digital and postal mode of delivery. All veteran patients targeted also received an educational intervention (postal delivery). Efficacy was measured using a linear mixed-effects model as the average number of gabapentinoid prescriptions standardized by defined daily dose (individual level), and number of veterans visiting a psychologist in the 6 and 12 months following the intervention.

Results: The trial involved 2552 general practitioners in Australia and took place in March 2020. Both intervention groups had a significant reduction in total gabapentinoid prescription by the end of the study period (digital: mean reduction of 11.2%, P=.004; postal: mean reduction of 11.2%, P=.001). We found no difference between digital and postal mode of delivery in reduction of gabapentinoid prescriptions at 12 months (digital: -0.058, postal: -0.058, P=.98). Digital delivery increased initiations to psychologists at 12 months (digital: 3.8%, postal: 2.0%, P=.02).

Conclusions: Our digitally delivered professional behavior change intervention was feasible, had comparable effectiveness to the postal intervention with regard to changes in medicine use, and had increased effectiveness with regard to referrals to a psychologist. Given the logistical benefits of digital delivery in nationwide programs, the results encourage exploration of this mode in future interventions.

Keywords: audit and feedback; digital health; digital intervention; health education; health professional; physician; precision public health; primary care.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Example of the intervention delivered to general practitioners (digital version).
Figure 2
Figure 2
CONSORT (Consolidated Standards of Reporting Trials) flowchart. GP: general practitioner.
Figure 3
Figure 3
Average daily DDD by intervention group. DDD: defined daily dose.
See this image and copyright information in PMC

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References

    1. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O'Brien MA, Johansen M, Grimshaw J, Oxman AD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012 Jan;6:CD000259. doi: 10.1002/14651858.CD000259.pub3. - DOI - PMC - PubMed
    1. Landis-Lewis Z, Brehaut JC, Hochheiser H, Douglas GP, Jacobson RS. Computer-supported feedback message tailoring: theory-informed adaptation of clinical audit and feedback for learning and behavior change. Implement Sci. 2015 Jan 21;10(1):12–12. doi: 10.1186/s13012-014-0203-z. https://implementationscience.biomedcentral.com/articles/10.1186/s13012-... s13012-014-0203-z - DOI - DOI - PMC - PubMed
    1. Dombrowski SU, O'Carroll RE, Williams B. Form of delivery as a key 'active ingredient' in behaviour change interventions. Br J Health Psychol. 2016 Nov;21(4):733–740. doi: 10.1111/bjhp.12203. - DOI - PubMed
    1. Black N, Eisma MC, Viechtbauer W, Johnston M, West R, Hartmann-Boyce J, Michie S, de Bruin M. Variability and effectiveness of comparator group interventions in smoking cessation trials: a systematic review and meta-analysis. Addiction. 2020 Sep 11;115(9):1607–1617. doi: 10.1111/add.14969. http://europepmc.org/abstract/MED/32043675 - DOI - PMC - PubMed
    1. Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2010;12(1):e4. doi: 10.2196/jmir.1376. http://www.jmir.org/2010/1/e4/ v12i1e4 - DOI - PMC - PubMed

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