{"abstracts":[{"sha1":"2e53d8ba6aa5f66f2750e848ff246db14c63ea33","content":"\nBackground\nWe previously reported on a randomised trial demonstrating the effectiveness and cost-effectiveness of a pharmacist-led information technology intervention (PINCER). We sought to investigate whether PINCER was effective in reducing hazardous prescribing when rolled out at scale in UK general practices.\n\n\nMethods and findings\nWe used a multiple interrupted time series design whereby successive groups of general practices received the PINCER intervention between September 2015 and April 2017. We used 11 prescribing safety indicators to identify potentially hazardous prescribing and collected data over a maximum of 16 quarterly time periods. The primary outcome was a composite of all the indicators; a composite for indicators associated with gastrointestinal (GI) bleeding was also reported, along with 11 individual indicators of hazardous prescribing. Data were analysed using logistic mixed models for the quarterly event numbers with the appropriate denominator, and calendar time included as a covariate.\nPINCER was implemented in 370 (94.1%) of 393 general practices covering a population of almost 3 million patients in the East Midlands region of England; data were successfully extracted from 343 (92.7%) of these practices. For the primary composite outcome, the PINCER intervention was associated with a decrease in the rate of hazardous prescribing of 16.7% (adjusted odds ratio (aOR) 0.83, 95% confidence interval (CI) 0.80 to 0.86) at 6 months and 15.3% (aOR 0.85, 95% CI 0.80 to 0.90) at 12 months postintervention. The unadjusted rate of hazardous prescribing reduced from 26.4% (22,503 patients in the numerator/853,631 patients in the denominator) to 20.1% (11,901 patients in the numerator/591,364 patients in the denominator) at 6 months and 19.1% (3,868 patients in the numerator/201,992 patients in the denominator). The greatest reduction in hazardous prescribing associated with the intervention was observed for the indicators associated with GI bleeding; for the GI composite indicator, there was a decrease of 23.9% at both 6 months (aOR 0.76, 95% CI 0.73 to 0.80) and 12 months (aOR 0.76, 95% CI 0.70 to 0.82) postintervention. The unadjusted rate of hazardous prescribing reduced from 31.4 (16,185 patients in the numerator/515,879 patients in the denominator) to 21.2% (7,607 patients in the numerator/358,349 patients in the denominator) at 6 months and 19.5% (2,369 patients in the numerator/121,534 patients in the denominator). We adjusted for calendar time and practice, but since this was an observational study, the findings may have been influenced by unknown confounding factors or behavioural changes unrelated to the PINCER intervention. Data were also not collected for all practices at 6 months and 12 months postintervention.\n\n\nConclusions\nThe PINCER intervention, when rolled out at scale in routine clinical practice, was associated with a reduction in hazardous prescribing by 17% and 15% at 6 and 12 months postintervention. The greatest reductions in hazardous prescribing were for indicators associated with risk of GI bleeding. These findings support the wider national rollout of PINCER in England.\n","mimetype":"application/xml+jats"}],"refs":[{"index":0,"extra":{"authors":["AJ Avery"],"doi":"10.3399/bjgp13x670679","issue":"11","volume":"63"},"key":"pmed.1004133.ref001","year":2013,"container_name":"Br J Gen Pract","title":"The prevalence and nature of prescribing and monitoring errors in English general practice: a retrospective case note review","locator":"543"},{"index":1,"extra":{"authors":["RL Howard"],"doi":"10.1111/j.1365-2125.2006.02698.x","volume":"63"},"key":"pmed.1004133.ref002","year":2007,"container_name":"Br J Clin Pharmacol","title":"Which drugs cause preventable admissions to hospital? A systematic review","locator":"136"},{"index":2,"extra":{"authors":["RA Elliott"],"doi":"10.1136/bmjqs-2019-010206","volume":"30"},"key":"pmed.1004133.ref003","year":2021,"container_name":"BMJ Qual Saf","title":"Economic analysis of the prevalence and clinical and economic burden of medication error in England.","locator":"96"},{"index":3,"extra":{"unstructured":"Geneva: World Health Organization Medication without harm—Global patient safety challenge on medication safety. 2017. Available from: http://www.who.int/initiatives/medication-without-harm [cited 2022 Feb 15]."},"key":"pmed.1004133.ref004"},{"index":4,"extra":{"authors":["A Avery"],"doi":"10.1016/s0140-6736(11)61817-5","volume":"379"},"key":"pmed.1004133.ref005","year":2012,"container_name":"Lancet","title":"A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis","locator":"1310"},{"index":5,"extra":{"authors":["R Spencer"],"doi":"10.3399/bjgp14x677806","issue":"621","volume":"64"},"key":"pmed.1004133.ref006","year":2014,"container_name":"BJGP","title":"Identification of an updated set of prescribing-safety indicators for GPs","locator":"e181"},{"index":6,"extra":{"authors":["S Rodgers"],"issue":"Suppl. 2","volume":"30"},"key":"pmed.1004133.ref007","year":2021,"container_name":"Pharmacoepidemiol Drug Saf","title":"Using CHART Online Comparative analysis service to support the national rollout of PINCER"},{"index":7,"extra":{"authors":["T Dreischulte"],"doi":"10.1056/nejmsa1508955","issue":"11","volume":"374"},"key":"pmed.1004133.ref008","year":2016,"container_name":"N Engl J Med","title":"Safer prescribing—a trial of education, informatics, and financial incentives","locator":"1053"},{"index":8,"extra":{"authors":["R Williams"]},"key":"pmed.1004133.ref009","year":2018,"container_name":"BMJ Health Care Inform","title":"SMASH! The Salford medication safety dashboard","locator":"25"},{"index":9,"extra":{"authors":["N Peek"],"doi":"10.1371/journal.pmed.1003286","issue":"10","volume":"17"},"key":"pmed.1004133.ref010","year":2020,"container_name":"PLoS Med","title":"Evaluation of a pharmacist-led actionable audit and feedback intervention for improving medication safety in UK primary care: An interrupted time series analysis","locator":"e1003286"},{"index":10,"extra":{"authors":["National Institute for Health and Care Excellence"]},"key":"pmed.1004133.ref011","container_name":"Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes"},{"index":11,"extra":{"unstructured":"Exploring Social Franchising. Available from: https://www.health.org.uk/funding-and-partnerships/programmes/exploring-social-franchising [cited 2022 Feb 15]."},"key":"pmed.1004133.ref012"},{"index":12,"extra":{"unstructured":"PRIMIS and PINCER. Available from: https://www.nottingham.ac.uk/primis/qi-services/projects/pincer/pincer-intervention.aspx [cited 2022 Mar 3]."},"key":"pmed.1004133.ref013"},{"index":13,"extra":{"unstructured":"The NHS Patient Safety Strategy. Available from: https://www.england.nhs.uk/wp-content/uploads/2020/08/190708_Patient_Safety_Strategy_for_website_v4.pdf [cited 2022 Feb 15]."},"key":"pmed.1004133.ref014"},{"index":14,"extra":{"unstructured":"Network Contract Directed Enhanced Service. Investment and Impact Fund 2022/23: Updated Guidance. Available from: https://www.england.nhs.uk/wp-content/uploads/2022/03/B1357-investment-and-impact-fund-2022-23-updated-guidance-march-2022.pdf [cited 2022 Jul 15]."},"key":"pmed.1004133.ref015"},{"index":15,"extra":{"authors":["RA Elliott"],"doi":"10.1007/s40273-014-0148-8","volume":"32"},"key":"pmed.1004133.ref016","year":2014,"container_name":"Pharmacoeconomics","title":"Cost effectiveness of a pharmacist-led information technology intervention for reducing rates of clinically important errors in medicines management in general practices (PINCER).","locator":"573"},{"index":16,"extra":{"unstructured":"Avoiding patient harm through the application of prescribing safety indicators in English general practices (acronym: PRoTeCT). Available from: https://fundingawards.nihr.ac.uk/award/RP-PG-1214-20012 [cited 2022 Feb 15]."},"key":"pmed.1004133.ref017"}],"contribs":[{"index":0,"creator_id":"2ixcmt4qxzfozbmk2emsv74aym","creator":{"orcid":"0000-0003-1676-1982","surname":"Rodgers","given_name":"Sarah","display_name":"Sarah Rodgers","state":"active","ident":"2ixcmt4qxzfozbmk2emsv74aym","revision":"e3e2e09c-be30-48de-9c39-d62041b46982"},"raw_name":"Sarah Rodgers","given_name":"Sarah","surname":"Rodgers","role":"author","extra":{"seq":"first"}},{"index":1,"creator_id":"cmh4wpvcyvcebjhgc65g2stjsi","creator":{"orcid":"0000-0002-8875-5779","surname":"Taylor","given_name":"Amelia","display_name":"Amelia Taylor","state":"active","ident":"cmh4wpvcyvcebjhgc65g2stjsi","revision":"30d29d6c-ac2f-4c7b-9a9d-b0e9b568d45c"},"raw_name":"Amelia C. 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Avery","given_name":"Anthony J.","surname":"Avery","role":"author"}],"language":"en","publisher":"Public Library of Science (PLoS)","pages":"e1004133","issue":"11","volume":"19","ext_ids":{"doi":"10.1371/journal.pmed.1004133","pmid":"36383560","pmcid":"PMC9718399"},"release_year":2022,"release_date":"2022-11-16","release_stage":"published","release_type":"article-journal","container_id":"iznnn644szdwva7khyxqzc73bi","webcaptures":[],"filesets":[],"files":[{"release_ids":["hlj6puwmxzgo7kkvd4esopureu"],"mimetype":"application/pdf","urls":[{"url":"https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1004133&type=printable","rel":"publisher"},{"url":"https://web.archive.org/web/20221123230214/https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1004133&type=printable","rel":"webarchive"}],"sha256":"65cffb3a014e9ff41b5fe4b6f3d48e831c0b4f61575065f02461e31b1afa94a9","sha1":"c6ebcaae23210e51477df7b6d1c7aa0f41597f8a","md5":"ef0adab15cb6cae669c1656ef0c7e645","size":1310229,"revision":"71914499-4548-4d91-a021-e6c91813756b","ident":"nzuob4skmjfsvgq2uoetx3wivi","state":"active"}],"container":{"wikidata_qid":"Q1686921","issnp":"1549-1277","issne":"1549-1676","issnl":"1549-1277","publisher":"Public Library of Science","container_type":"journal","name":"PLoS Medicine","extra":{"abbrev":"PLoS Med.","country":"us","default_license":"CC-BY","doaj":{"archive":["PMC"],"as_of":"2022-07-06","default_license":"CC-BY","seal":true},"kbart":{"lockss":{"year_spans":[[2004,2009]]}},"languages":["en"],"publisher_type":"oa","road":{"as_of":"2018-01-24"},"sherpa_romeo":{"color":"green"},"urls":["https://journals.plos.org/plosmedicine/","http://www.plosmedicine.org/"]},"revision":"6511f755-9fb2-471e-8e54-f9dddcc83658","ident":"iznnn644szdwva7khyxqzc73bi","state":"active"},"work_id":"jbb7libb4zb5bhf3sizyteeioi","title":"Scaling-up a pharmacist-led information technology intervention (PINCER) to reduce hazardous prescribing in general practices: Multiple interrupted time series study","state":"active","ident":"hlj6puwmxzgo7kkvd4esopureu","revision":"c6012c10-8ed0-4f05-9629-8cdfb267d592","extra":{"crossref":{"funder":[{"award":["7419"],"name":"Health Foundation"},{"award":["7419"],"name":"Health Foundation"},{"award":["7419"],"name":"Health Foundation"},{"award":["7419"],"name":"Health Foundation"},{"award":["7419"],"name":"Health Foundation"},{"award":["7419"],"name":"Health Foundation"},{"DOI":"10.13039/501100000724","award":["7419"],"doi-asserted-by":"crossref","name":"The Health Foundation"},{"award":["7419"],"name":"Health Foundation"},{"award":["39701"],"name":"East Midlands Academic Health Science Network"},{"award":["39701"],"name":"East Midlands Academic Health Science Network"},{"DOI":"10.13039/501100013235","award":["PSTRC-2016-003"],"doi-asserted-by":"publisher","name":"NIHR Greater Manchester Patient Safety Translational Research Centre"},{"name":"National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands"},{"DOI":"10.13039/501100020013","doi-asserted-by":"publisher","name":"NIHR Leicester Biomedical Research Centre"}],"subject":["General Medicine"],"type":"journal-article"},"pubmed":{"pub_types":["Journal Article"]}}}