Niall Furlong

Delivering improved management and outcomes in diabetic kidney disease in routine clinical care

Aim T o examine the impact of service re-design on management and outcomes in type 2 diabetic patients with microalbuminuria and diabetic nephropathy. Methods The impact of implementation of evidence-based processes of care (blood pressure [BP] control, glycaemic control, renin-angiotensin-aldosterone system blockade, aspirin and cholesterol-lowering therapy, and smoking cessation) on progression to nephropathy in 338 microalbuminuria patients; and on death, doubling of serum creatinine, new end-stage renal failure (ESRF) and cardiovascular events in 127 nephropathy patients is described. Results Effective implementation of evidence-based processes of care improved surrogate outcomes (BP, HbA 1C and low density lipoprotein-cholesterol), was associated with little progression of microalbuminuria to nephropathy (6.1 per 100-patient-years), and in diabetic nephropathy patients were associated with rates of doubling of serum creatinine (1.4 per 100-patient-years), progression to ESRF (1.1 per 100-patient-years), cardiovascular events (3.2 per 100-patient-years) and mortality (2.2 per 100-patient-years) that compares favourably with landmark trials. Conclusion Service re-design in the management of type 2 diabetic kidney disease can deliver improved care and outcomes comparable with landmark trials in a routine clinical care setting. Br J Diabetes Vasc Dis 2007;7:172-8

Exploring the impact of pharmacist-led feedback on prescribing behaviour: A qualitative study

Background Prescribing errors occur frequently in hospital settings. Interventions to influence prescribing behaviour are needed with feedback one potential intervention to improve prescribing practice. Doctors have reported a lack of feedback on their prescribing previously whilst the literature exploring the impact of feedback on prescribing behaviour is limited. Objectives To explore the impact of pharmacist‐led feedback on prescribing behaviour. Methods Semi‐structured interviews were conducted with doctors who had received prescribing error feedback. A topic guide was used to explore the type of error and what impact feedback was having on prescribing behaviour. All interviews were transcribed verbatim and analysed thematically using a framework approach. Results Twenty‐three prescribers were interviewed and 65 errors discussed over 38 interviews. Key themes included; affective behaviour, learning outcome, prescribing behaviour and likelihood of error recurrence. Feedback was educational whilst a range of adaptive prescribing behaviours were also reported. Prescribers were more mindful and engaged with the prescribing process whilst feedback facilitated reflection, increased self‐awareness and informed self‐regulation. Greater information and feedback‐seeking behaviours were reported whilst prescribers also reported greater situational awareness, and that they were making fewer prescribing errors following feedback. Conclusions Pharmacist‐led feedback was perceived to positively influence prescribing behaviour. Reported changes in prescriber behaviour resonate with the non‐technical skills (NTS) of prescribing with prescribers adapting their prescribing behaviour depending on the environment and prescribing conditions. A model of prescribing is proposed with NTS activated in response to error provoking conditions. These findings have implications for prescribing education to make it a more contextualised educational process.

Exploring pharmacist experiences of delivering individualised prescribing error feedback in an acute hospital setting

Highlights:Delivery of prescribing error feedback is valued by hospital pharmacists and considered sustainable.Pharmacists report altered prescribing behaviour and improved prescribing following receipt of feedback.Pharmacists report greater team‐work and prescriber communication following delivery of feedback.Delivering prescribing error feedback can improve the self‐confidence and self‐worth of pharmacists.