Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners

Just Accepted

This article has been peer reviewed and accepted for publication. It is in production and has not been edited, so may differ from the final published form.

Safer Prescribing and Care for the Elderly (SPACE): feasibility of audit and feedback plus practice mail-out to patients with high-risk prescribing

Katharine Wallis , Rebecca Tuckey

Abstract

Introduction: Avoidable adverse drug event hospitalisations in older people are common and costly. The most effective, cost-effective and practical approach to safer prescribing in everyday practice is not yet known. The SPACE intervention combines audit and feedback with practice mail-out to patients with high-risk prescribing. Aim: The aim of this study was to test the feasibility of the SPACE intervention in New Zealand general practice. Design: Feasibility study using semi-structured interviews. Setting: One Auckland Primary Health Organisation (PHO) and two purposively sampled urban general practices. Participants: The clinical advisory pharmacist, general practitioners (GPs), and patients who received the mail-out. Main outcome measures: Participant views on the acceptability and utility of the SPACE intervention. Interviews were audio-recorded, transcribed verbatim and analysed using a general inductive approach to identify emergent themes. Results: The clinical advisory pharmacist, seven doctors, and eleven of 29 patients who received the mail-out were interviewed. The SPACE intervention provides a structured format for clinical advisory pharmacists to do what PHOs employ them to do at no extra cost. Doctors said they appreciated the education and the prompt to review prescribing. Some doctors were concerned the mail-out might upset patients, but patients said they were reassured to receive the mail-out and to know someone was checking their medicines. Some patients said they would take the letter to their next appointment and use it to prompt a discussion with their doctor about their medicines, but other patients said there was not enough time in a consultation to talk to their doctor about their medicines. Some patients were confused by the medicines information brochure. Discussion: The SPACE intervention is feasible in general practice. The medicines information brochure needs simplification. Further work is needed to test in a larger trial the effect of SPACE on the rates of high-risk prescribing.

HC17018  Accepted 10 May 2017

© CSIRO 2017