Co-Designing High-Risk Drug Alerts for Health and Community Service Practitioners

Abstract

Background Alerts about drug market changes (e.g., drug strength, purity, adulterations, or other trends) may be useful to assist health and community workers to anticipate, prevent and respond to unexpected adverse drug events. This study aimed to establish factors influencing the successful design and implementation of drug alerts for use in clinical and community settings in Victoria, Australia. Methods We used an iterative, parallel mixed methods participatory design to co-produce drug alert prototypes with practitioners and managers working across alcohol and other drugs and emergency medicine settings. A quantitative needs-analysis survey (n = 184) informed five qualitative co-design workshops (n = 31). Alert prototypes were drafted based on findings and presented for testing of utility and acceptability. Applicable constructs from the Consolidated Framework for Implementation Research helped to identify key barriers and facilitators to successful alert design. Results Timely and reliable alerts about high-risk single substances were important to nearly all practitioners (98%) yet many reported insufficient access to timely information about drug markets and emerging threat (64%). Alerts were useful for increasing exposure to drug market intelligence; facilitating risk communication; and improving capacity for effective responses. Alerts must be ‘shareable’ across a range of settings to meet the needs of diverse professional and public audiences. Practitioners and managers considered themselves ‘conduits’ for information sharing. To maximize engagement and impact, alerts must be attention-grabbing and easily recognisable; available on multiple platforms; published in printable and electronic formats in varying levels of detail; and disseminated using appropriate notification mechanisms. Three clinical drug alert prototypes (SMS prompt, summary flier, and detailed PDF) were developed and considered acceptable and useful for a range of audiences and settings. Discussion Adequate planning and resourcing for effective drug alert design and evaluation arising from jurisdictional and national early warning systems is imperative to their utility. Such systems need to have access to reliable multidisciplinary drug market intelligence for rapid assessment and verification of risk to report timely and effective risk communications. Systems that offer close to real-time detection of adulterants/contaminants (e.g., drug checking services) are best-placed to provide rapid, evidence-based drug market intelligence to inform preventive and responsive action.