Investigation of the effect of a countywide protected learning time scheme on prescribing rates of ramipril: interrupted time series study

Siriwardena, Aloysius Niroshan; Fairchild, Pamela S.; Gibson, Sharon K.; Sach, Tracey; Dewey, Michael

doi:10.1093/fampra/cml051

Cited by 8 publications

(69 citation statements)

References 13 publications

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“…Contexts at the interpersonal level included: primary care teams; and multidisciplinary teams . At the organisational level contexts included: hospital; general practice; ward round; increased patient numbers; and rapid NHS change . See Box 2 for examples of these contexts in the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…With respect to negative mechanisms at the interpersonal level, we identified: trainers can stifle trainees . Finally, in terms of the organisational level, we identified the following negative mechanisms: lack of funding; pressures on service; lack of protection from service obligations; lack of support; lack of staff cover; short placements; and single‐handed roles . See Box 2 for examples of both positive and negative mechanisms.…”

Section: Resultsmentioning

confidence: 99%

“…Protected learning time (PLT) [I] in primary care [C] can lead to updated knowledge and skills and improved teamwork and relationships [O] for all staff categories [C], but only if it is perceived to be relevant and valuable, and if there is effective communication and protection from service delivery obligations [M]:

Studies have shown that PLT [I] is generally well received [O] but that different professional and occupational groups [C] have varying perceptions and experiences of PLT [O] …”

Section: Resultsmentioning

confidence: 99%

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Balancing health care education and patient care in the UK workplace: a realist synthesis

et al. 2017

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CONTEXT Patient care activity has recently increased without a proportionate rise in workforce numbers, impacting negatively on health care workplace learning. Health care professionals are prepared in part by spending time in clinical practice, and for medical staff this constitutes a contribution to service. Although stakeholders have identified the balance between health care professional education and patient care as a key priority for medical education research, there have been very few reviews to date on this important topic. METHODSWe conducted a realist synthesis of the UK literature from 1998 to answer two research questions. (1) What are the key workplace interventions designed to help achieve a balance between health care professional education and patient care delivery? (2) In what ways do interventions enable or inhibit this balance within the health care workplace, for whom and in what contexts? We followed Pawson's five stages of realist review: clarifying scope, searching for evidence, assessment of quality, data extraction and data synthesis. RESULTSThe most common interventions identified for balancing health care professional education and patient care delivery were ward round teaching, protected learning time and continuous professional development. The most common positive outcomes were simultaneous improvements in learning and patient care or improved learning or improved patient care. The most common contexts in which interventions were effective were primary care, postgraduate trainee, nurse and allied health professional contexts. By far the most common mechanisms through which interventions worked were organisational funding, workload management and support.CONCLUSION Our novel findings extend existing literature in this emerging area of health care education research. We provide recommendations for the development of educational policy and practice at the individual, interpersonal and organisational levels and call for more research using realist approaches to evaluate the increasing range of complex interventions to help balance health care professional education and patient care delivery.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Studies have shown that PLT [I] is generally well received [O] but that different professional and occupational groups [C] have varying perceptions and experiences of PLT [O] …”

Section: Resultsmentioning

confidence: 99%

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Balancing health care education and patient care in the UK workplace: a realist synthesis

et al. 2017

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“…There was an 87-fold difference among English GPs in its prescribing of lansoprazole in the late 1990s following its introduction to the market as a cheaper PPI (4). The majority of studies which have examined attempts to change prescribing have done so in relation to one medication class only (21,38). This paper is novel in that seeks to examine changes in prescribing for two drug groups simultaneously, either groups for which guidelines were issued simultaneously or by using a reference group for which no guidelines were issued during the study period.…”

Section: Context Of Other Studiesmentioning

confidence: 99%

Prescriber Variation in Relation to Prescribing Trends within the Preferred Drugs Initiative in Ireland (2012–2015): An Interrupted Time-Series Study Using Latent Curve Models

et al. 2019

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Objectives: To examine the impact of the Preferred Drugs Initiative (PDI), an Irish health policy aimed at reducing prescribing variation. Design: Interrupted time series spanning 2012 to 2015. Setting: Health Service Executive pharmacy claims data for General Medical Services (GMS) patients, approximately 40% of the Irish population. Participants: Prescribers issuing preferred drug group items to GMS adults before and after PDI guidelines. Primary outcome: The percentage coverage of PDI medications within each drug class per calendar quarter per prescriber. Methods: Latent curve models with structured residuals (LCM-SR) were used to model coverage of the preferred drugs over time. The number of GMS adults receiving medication and the percentage who were 65 years and over at the start of the study were included as covariates. Results: In the quarter following PDI guidelines, coverage of the preferred drugs increased most in absolute terms for proton pump inhibitors (PPIs) (1.50% (SE 0.15), p<0.001) and selective and norepinephrine reuptake inhibitors (SNRIs) (1.17% (SE 0.26), p<0.001). Variation between prescribers remained relatively unchanged and increased for urology medications. Prescribers who increased coverage of the preferred PPI also increased coverage of the preferred statin immediately following guidelines (correlation 0.47 (SE 0.13), p<0.001). Where guidelines were disseminated simultaneously, coverage of one preferred drug did not significantly predict coverage of the other preferred drug in the next calendar quarter. Prescribing of preferred drugs was not moderated by prescriber-level factors. Conclusions: Modest changes in prescribing of the preferred drugs have been observed over the course of the PDI. However the guidelines have had little impact in reducing variation between prescribers. Further strategies may be necessary to reduce variation in clinical practice and enhance patient care.

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“…Like traditional interrupted time series models and regime switching time series models used in assessing the impact of an intervention on medical costs [25][26][27][28][29][30][31][32] , the model devised for this study included a stochastic component represented by autoregressive, integrated, moving average parts of ARIMA (p, d, q), and structural or interventional components. However, different from these traditional time series models, our novelly-devised models decomposed the structural/or interventional component into the following four sub-components: (1) marginal (or monthly) change of medical costs in the absence of a treatment initiation, (2) marginal (or monthly) change of medical costs in the presence of a treatment initiation, (3) short-term change of medical costs at initiation, and (4) additional impact of a treatment initiation over the observed time period.…”

Section: Time Series Analysismentioning

confidence: 99%

Evolutionary cost analysis of valsartan initiation among patients with hypertension: a time series approach

Sun¹,

Chang

Zhang

et al. 2011

Journal of Medical Economics

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Investigation of the effect of a countywide protected learning time scheme on prescribing rates of ramipril: interrupted time series study

Abstract: PLT schemes can contribute to beneficial changes in prescribing across a large geographical area.

Cited by 8 publications

References 13 publications

Balancing health care education and patient care in the UK workplace: a realist synthesis

Balancing health care education and patient care in the UK workplace: a realist synthesis

Prescriber Variation in Relation to Prescribing Trends within the Preferred Drugs Initiative in Ireland (2012–2015): An Interrupted Time-Series Study Using Latent Curve Models

Evolutionary cost analysis of valsartan initiation among patients with hypertension: a time series approach

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