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Protocol for the Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) study: a cluster randomised controlled trial using ePrescribing data
  1. Bruce Guthrie1,
  2. Shaun Treweek1,
  3. Dennis Petrie2,
  4. Karen Barnett3,
  5. Lewis D Ritchie4,
  6. Chris Robertson5,
  7. Marion Bennie6
  1. 1Population Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, UK
  2. 2Department of Economics, University of Dundee, Dundee, UK
  3. 3Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
  4. 4Department of General Practice and Primary Care, University of Aberdeen, Aberdeen, UK
  5. 5Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
  6. 6Department of Pharmaceutical Sciences, University of Strathclyde, Glasgow, UK
  1. Correspondence to Bruce Guthrie; b.guthrie{at}


Introduction High-risk prescribing in primary care is common and causes considerable harm. Feedback interventions to improve care are attractive because they are relatively cheap to widely implement. There is good evidence that feedback has small to moderate effects, but the most recent Cochrane review called for more high-quality, large trials that explicitly test different forms of feedback.

Methods and analysis The study is a three-arm cluster-randomised trial with general practices being randomised and outcomes measured at patient level. 262 practices in three Scottish Health Board areas have been randomised (94% of all possible practices). The two active arms receive different forms of prescribing safety data feedback, with rates of high-risk prescribing compared with a ‘usual care’ arm. Sample size estimation used baseline data from participating practices. With 85 practices randomised to each arm, then there is 93% power to detect a 25% difference in the percentage of high-risk prescribing (from 6.1% to 4.5%) between the usual care arm and each intervention arm. The primary outcome is a composite of six high-risk prescribing measures (antipsychotic prescribing to people aged ≥75 years; non-steroidal anti-inflammatory drug (NSAID) prescribing to people aged ≥75 without gastroprotection; NSAID prescribing to people prescribed aspirin/clopidogrel without gastroprotection; NSAID prescribing to people prescribed an ACE inhibitor/angiotensin receptor blocker and a diuretic; NSAID prescription to people prescribed an oral anticoagulant without gastroprotection; aspirin/clopidogrel prescription to people prescribed an oral anticoagulant without gastroprotection). The primary analysis will use multilevel modelling to account for repeated measurement of outcomes in patients clustered within practices.

Ethics and dissemination The study was reviewed and approved by the NHS Tayside Committee on Medical Research Ethics B (11/ES/0001). The study will be disseminated via a final report to the funder with a publicly available research summary, and peer reviewed publications.

Trial registration, dossier number NCT01602705.

  • Primary Care
  • Clinical Pharmacology
  • Randomised controlled trials
  • Audit and feedback
  • Medication review
  • Medication errors

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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