Implementation and Evaluation of a Digitally Enabled Precision Public Health Intervention to Reduce Inappropriate Gabapentinoid Prescription: Cluster Randomized Controlled Trial.

BACKGROUND: Digital technologies can enable rapid targeted delivery of audit and feedback interventions at scale. Few studies have evaluated how mode of delivery affects clinical professional behavior change and none have assessed the feasibility of such an initiative at a national scale. OBJECTIVE: The aim of this study was to develop and evaluate the effect of audit and feedback by digital versus postal (letter) mode of delivery on primary care physician behavior. METHODS: This study was developed as part of the Veterans' Medicines Advice and Therapeutics Education Services (MATES) program, an intervention funded by the Australian Government Department of Veterans' Affairs that provides targeted education and patient-specific audit with feedback to Australian general practitioners, as well as educational material to veterans and other health professionals. We performed a cluster randomized controlled trial of a multifaceted intervention to reduce inappropriate gabapentinoid prescription, comparing digital and postal mode of delivery. All veteran patients targeted also received an educational intervention (postal delivery). Efficacy was measured using a linear mixed-effects model as the average number of gabapentinoid prescriptions standardized by defined daily dose (individual level), and number of veterans visiting a psychologist in the 6 and 12 months following the intervention. RESULTS: The trial involved 2552 general practitioners in Australia and took place in March 2020. Both intervention groups had a significant reduction in total gabapentinoid prescription by the end of the study period (digital: mean reduction of 11.2%, P=.004; postal: mean reduction of 11.2%, P=.001). We found no difference between digital and postal mode of delivery in reduction of gabapentinoid prescriptions at 12 months (digital: -0.058, postal: -0.058, P=.98). Digital delivery increased initiations to psychologists at 12 months (digital: 3.8%, postal: 2.0%, P=.02). CONCLUSIONS: Our digitally delivered professional behavior change intervention was feasible, had comparable effectiveness to the postal intervention with regard to changes in medicine use, and had increased effectiveness with regard to referrals to a psychologist. Given the logistical benefits of digital delivery in nationwide programs, the results encourage exploration of this mode in future interventions.

Student evaluation of an instructional video on how to use a national medicines information resource.

OBJECTIVES: The objective of this project was to obtain students' perception of an educational companion video designed to increase the understanding of a national medicines information resource. METHODS: An instructional video was developed to guide students in utilizing the online version of the Australian Medicines Handbook (AMH). All students enrolled in the Bachelor of Pharmacy program during 2021 were given access to this video. A cross-sectional electronic survey was administered to evaluate the video's effectiveness and its impact on students' confidence. The survey results were analysed using both descriptive and inferential statistics, in addition to qualitative analysis to identify common themes. Ethics approval was obtained prior to conducting the study. KEY FINDINGS: Most students (78%; n = 72/92) reported that watching the video increased their understanding. The most growth in confidence was seen by students in their first or second year of study. Fifty-four percent (n = 48/89) of students was very likely or extremely likely to recommend the video to others, and 37% (n = 33/89) of students were somewhat likely. Students found the instructional video to be useful and expressed a desire for similar content to be integrated into other facets of teaching. The audio-visual mode of delivery was regarded as effective for this context. Constructive feedback included suggestions of incorporating more advanced educational features such as how to interpret comparative medication charts and interaction checkers. CONCLUSIONS: The 'How to use the AMH' video is a good introductory resource for undergraduate Australian healthcare students. Our results indicate that this video would be best suited to complement the teaching of students early on in their studies.

Precision public-health intervention for care coordination: a real-world study.

BACKGROUND: Health emergencies disproportionally affect vulnerable populations. Digital tools can help primary care providers find, and reach, the right patients. AIM: To evaluate whether digital interventions delivered directly to GPs' clinical software were more effective at promoting primary care appointments during the COVID-19 pandemic than interventions delivered by post. DESIGN AND SETTING: Real-world, non-randomised, interventional study involving GP practices in all Australian states. METHOD: Intervention material was developed to promote care coordination for vulnerable older veterans during the COVID-19 pandemic, and sent to GPs either digitally to the clinical practice software system or in the post. The intervention material included patient-specific information sent to GPs to support care coordination, and education material sent via post to veterans identified in the administrative claims database. To evaluate the impact of intervention delivery modalities on outcomes, the time to first appointment with the primary GP was measured; a Cox proportional hazards model was used, adjusting for differences and accounting for pre-intervention appointment numbers. RESULTS: The intervention took place in April 2020, during the first weeks of COVID-19 social distancing restrictions in Australia. GPs received digital messaging for 51 052 veterans and postal messaging for 26 859 veterans. The digital group was associated with earlier appointments (adjusted hazard ratio 1.38 [1.34 to 1.41]). CONCLUSION: Data-driven digital solutions can promote care coordination at scale during national emergencies, opening up new perspectives for precision public-health initiatives.

Consumer-pharmacist interactions around complementary medicines: agreement between pharmacist and consumer expectations, satisfaction and pharmacist influence.

OBJECTIVE: To explore pharmacist-consumer interactions around the use of complementary medicines (CMs), with specific focus on consumer expectations, perceptions and satisfaction. METHODS: Twenty pharmacists and 20 healthcare consumers were recruited across 16 metropolitan community pharmacies in Adelaide, Australia, from June to August 2011. Semi-structured interviews containing comparable questions for both study groups were used. Data was transcribed and analysed with the aid of AutoMap®. KEY FINDINGS: There was high consumer satisfaction with pharmacists as CM providers, which was in agreement with pharmacist's perceptions of consumer satisfaction. However, this was against a background of low consumer expectations and pharmacists' dissatisfaction with their own role in the interaction. Consumers often perceived pharmacy-stocked CMs to be more effective and safer compared to those in supermarkets or health food shops, but this perception was not shared by pharmacists. Pharmacists believed they had significant influence around recommendation and use of CMs, whereas consumers perceived a more limited influence. Both pharmacists and consumers shared similar perceptions of CM safety and similar expectations regarding business influence and professional pressures on information provision. CONCLUSION: Behind a perception of high satisfaction, consumers have low expectations of pharmacists around provision of CM-related information. Further work is required to improve pharmacists' knowledge and confidence around CM use and to address barriers such as the tension between potentially competing business pressures and professional responsibilities.

XForms and XML events to support decisions about medication management.

Representation and presentation of information in healthcare is problematic, including issues related to common formats and accessibility. XML technology infrastructure (particularly XForms and XML events) appears promising in addressing some of these issues. These technologies were investigated in the context of decision support for medication management. XForms allows rapid prototyping of information models and interfaces. XML events are useful to model simple alerts although currently limited by some components, such as date functionality.