Repeated analyses of national clinical audit reports demonstrate improvements in feedback methods

Khan, Tasneem; Alderson, Sarah; Francis, Jill J; Lorencatto, Fabiana; Grant‐Casey, John; Stanworth, Simon; Foy, Robbie

doi:10.1186/s43058-020-00089-3

Cited by 12 publications

(12 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We also identified potential weaknesses in feedback cycles, such as the omission of specific actions plans for improvement and limited demonstration of audit impacts on patient care and outcomes. We have previously demonstrated variations in how feedback is delivered by UK national clinical audit programmes [ 13 ]. This closer analysis and comparison of two audit programmes has highlighted a range of opportunities to improve impacts specific to each programme.…”

Section: Discussionmentioning

confidence: 99%

“…A repeated analysis of UK national clinical audit reports identified trends towards the use of more effective feedback methods (e.g. greater use of recommendations for action) and identified further opportunities for improvement [ 13 ]. CP-FIT offers a rigorously derived framework for evaluating feedback interventions and explaining their observed or predicted effects [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Opportunities to improve the impact of two national clinical audit programmes: a theory-guided analysis

Willis

Wood

Brehaut

et al. 2022

Implement Sci Commun

View full text Add to dashboard Cite

Background Audit and feedback is widely used in healthcare improvement, with evidence of modest yet potentially important effects upon professional practice. There are approximately 60 national clinical audit programmes in the UK. These programmes often develop and adapt new ways of delivering feedback to optimise impacts on clinical practice. Two such programmes, the National Diabetes Audit (NDA) and the Trauma Audit Research Network (TARN), recently introduced changes to their delivery of feedback. We assessed the extent to which the design of these audit programmes and their recent changes were consistent with best practice according to the Clinical Performance Feedback Intervention Theory (CP-FIT). This comprehensive framework specifies how variables related to the feedback itself, the recipient, and the context operate via explanatory mechanisms to influence feedback success. Methods We interviewed 19 individuals with interests in audit and feedback, including researchers, audit managers, healthcare staff, and patient and public representatives. This range of expert perspectives enabled a detailed exploration of feedback from the audit programmes. We structured interviews around the CP-FIT feedback cycle and its component processes (e.g. Data collection and analysis, Interaction). Our rapid analytic approach explored the extent to which both audits applied features consistent with CP-FIT. Results Changes introduced by the audit programmes were consistent with CP-FIT. Specifically, the NDA’s increased frequency of feedback augmented existing strengths, such as automated processes (CP-FIT component: Data collection and analysis) and being a credible source of feedback (Acceptance). TARN’s new analytic tool allowed greater interactivity, enabling recipients to interrogate their data (Verification; Acceptance). We also identified scope for improvement in feedback cycles, such as targeting of feedback recipients (Interaction) and feedback complexity (Perception) for the NDA and specifying recommendations (Intention) and demonstrating impact (Clinical performance improvement) for TARN. Conclusions The changes made by the two audit programmes appear consistent with suggested best practice, making clinical improvement more likely. However, observed weaknesses in the feedback cycle may limit the benefits of these changes. Applying CP-FIT via a rapid analysis approach helps identify strengths and remediable weaknesses in the design of audit programmes that can be shared with them in a timely manner.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Opportunities to improve the impact of two national clinical audit programmes: a theory-guided analysis

Willis

Wood

Brehaut

et al. 2022

Implement Sci Commun

View full text Add to dashboard Cite

show abstract

“…Studies using survey and patient data report a change in medication use during the pandemic [ 5 , 7 , 8 ]. Changes in service delivery have been monitored through multiple national audits, which often lag considerably behind the real-time [ 9 , 10 ]. There is an urgent need to focus appropriate resources on optimisation of medication dispensing monitoring systems, especially in vulnerable patient groups, for example those receiving immunosuppressive drugs [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 pandemic on community medication dispensing: a national cohort analysis in Wales, UK

Torabi

Akbari

Bedston

et al. 2022

IJPDS

View full text Add to dashboard Cite

BackgroundPopulation-level information on dispensed medication provides insight on the distribution of treated morbidities, particularly if linked to other population-scale data at an individual-level. ObjectiveTo evaluate the impact of COVID-19 on dispensing patterns of medications. MethodsRetrospective observational study using population-scale, individual-level dispensing records in Wales, UK. Total dispensed drug items for the population between 1st January 2016 and 31st December 2019 (3-years, pre-COVID-19) were compared to 2020 with follow up until 27th July 2021 (COVID-19 period). We compared trends across all years and British National Formulary (BNF) chapters and highlighted the trends in three major chapters for 2019-21: 1-Cardiovascular system (CVD); 2-Central Nervous System (CNS); 3-Immunological & Vaccine. We developed an interactive dashboard to enable monitoring of changes as the pandemic evolves. ResultAmongst all BNF chapters, 73,410,543 items were dispensed in 2020 compared to 74,121,180 items in 2019 demonstrating -0.96% relative decrease in 2020. Comparison of monthly patterns showed average difference (D) of -59,220 and average Relative Change (RC) of -0.74% between the number of dispensed items in 2020 and 2019. Maximum RC was observed in March 2020 (D= +1,224,909 and RC= +20.62%), followed by second peak in June 2020 (D= +257,920, RC= +4.50%). A third peak was observed in September 2020 (D= +264,138, RC= +4.35%). Large increases in March 2020 were observed for CVD and CNS medications across all age groups. The Immunological and Vaccine products dropped to very low levels across all age groups and all months (including the March dispensing peak). ConclusionsReconfiguration of routine clinical services during COVID-19 led to substantial changes in community pharmacy drug dispensing. This change may contribute to a long-term burden of COVID-19, raising the importance of a comprehensive and timely monitoring of changes for evaluation of the potential impact on clinical care and outcomes.

show abstract

“…Studies using survey and patient data, reported an observed change in medication use during the pandemic (5) (6). Changes in service delivery have been monitored through multiple national audits which often lag considerably behind in real-time (7) (8). There is an urgent need to focus appropriate resources on optimisation of medication dispensing monitoring systems, especially in vulnerable patient groups; for example those receiving immunosuppressive drugs (9).…”

Section: Introductionmentioning

confidence: 99%

Evaluating the effect of COVID-19 on dispensing patterns: a national cohort analysis

Torabi

Akbari

North

et al. 2021

Preprint

View full text Add to dashboard Cite

BackgroundMedication prescribing and dispensing often regarded as one of the most effective ways to manage and improve population health. Prescribed and dispensed medications can be monitored through data linkage for each patient. We hypothesised that changes in patient care resulting from COVID-19, changed the way patients access their prescribed medication.Objective To develop an efficient approach for evaluation of the impact of COVID-19 on drug dispensing patterns.MethodsRetrospective observational study using national patient-level dispensing records in Wales-UK. Total dispensed drug items between 01-Jan-2016 and 31-Dec-2019 (counterfactual pre-COVID-19) were compared to 2020 (COVID-19 year). We compared trends of dispensed items in three main British National Formulary (BNF) sections(Cardiovascular system, Central Nervous System, Immunological & Vaccine) using European Age-Standardized rates. We developed an online tool to enable monitoring of changes in dispensing as the pandemic evolves.ResultAmongst all BNF chapters, 52,357,639 items were dispensed in 2020 compared to 49,747,141 items in 2019 demonstrating a relative increase of 5.25% in 2020(95%CI[5.21,5.29]). Comparison of monthly patterns of 2020 and 2019 dispensed items showed a notable difference between the total number of dispensed drug items each month, with an average difference (D) of +290,055 and average Relative Change (RC) of +5.52%. The greatest RC was observed in a substantial March-2020 increase (D=+1,501,242 and RC=+28%), followed by second peak in June (D=+565,004, RC=+10.97%). May was characterised by lower dispensing (D=-399,244, RC=-5.9%). Cardiovascular categories were characterised, across all age groups, by dramatic March-2020 increases, at the epidemic peak, followed by months of lower than expected dispensing, and gradual recovery by September. The Central Nervous System category was similar, but with only a short decline in May, and quicker recovery. A stand-out grouping was Immunological and Vaccine, which dropped to very low levels across all age groups, and all months (including the March dispensing peak).ConclusionsAberration in clinical service delivery during COVID-19 led to substantial changes in community pharmacy drug dispensing. This change may contribute to a long-term burden of COVID-19, raising the importance of a comprehensive and timely monitoring of changes for evaluation of the potential impact on clinical care and outcomes

show abstract

Repeated analyses of national clinical audit reports demonstrate improvements in feedback methods

Cited by 12 publications

References 13 publications

Opportunities to improve the impact of two national clinical audit programmes: a theory-guided analysis

Opportunities to improve the impact of two national clinical audit programmes: a theory-guided analysis

Impact of COVID-19 pandemic on community medication dispensing: a national cohort analysis in Wales, UK

Evaluating the effect of COVID-19 on dispensing patterns: a national cohort analysis

Contact Info

Product

Resources

About