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Table 3 Summary table of the key results from the Delphi questionnaire

From: Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) a pragmatic three-arm cluster randomised trial: designing the intervention (ClinicalTrials.gov registration NCT01602705)

TPB constructs Delphi questionnaire: results
Attitude Consensus of agreement regarding ATTITUDES toward responding to prescribing feedback (≥75% agree/strongly agree; ≥6 GPs were outliers)

Reviewing patient prescribing was a positive thing to do for the patient.

Reviewing patient prescribing gave GPs a sense of protecting their patients.

The fear of a patient having a significant event as a result of receiving high-risk prescribing caused GPs concern.

Reviewing patient prescribing was important.

GPs do not regard receiving prescribing feedback as a criticism.

GPs would not feel defensive in response to receiving prescribing feedback.
There was disagreement among GP responses to the following statements (>25%; more than 6 GPs were outliers)

Being seen by my colleagues to have unwittingly prescribed a high-risk drug would be embarrassing.

A negative event as a result of changing prescribing in the past would make me less likely to change or stop medications in the future.
Subjective norms Consensus of agreement regarding the importance of other groups and the importance of their opinions to GPs (≥75% agree/strongly agree)

The groups of people most likely to approve of responding to prescribing feedback were the GMC, other GPs and practice pharmacists.

Approval from patients and GPs within their own practice was most important, followed by approval from the GMC then the practice pharmacist.
Perceived Behavioural Control (PCB) Consensus of agreement regarding the BARRIERS to respond to the prescribing feedback (≥75% agree/strongly agree)

GPs would be less likely to respond to the prescribing feedback if clinical guidelines are unclear, or there is no sound evidence base.

A negative event as a result of changing prescribing in the past would make GPs less likely to change or stop patient’s medication in the future.
There was disagreement among GP responses to the following statements (>25%)

I already have too much to do and would struggle to find time to review patients receiving high-risk prescribing.

I will not respond to the prescribing feedback if it appears difficult, or it is not clear what I need to do.

Even when it is high risk, I find it difficult to change my patients prescribing when they feel fine and are having little or no side effects from their medication.

I find stopping medications more difficult if the medication was started in secondary care.

Patient preferences are a key determinant for me when considering whether or not to change a patient’s medication.
Consensus of agreement regarding FACILITATORS of responding to the prescribing feedback (≥75% agree/strongly agree)

Prescribing feedback is more persuasive if the recommendations are in line with SIGN/NICE guidelines.

The messenger is important, and GPs would be more likely to respond to the prescribing feedback that came from the practice pharmacist, a respected clinician or the Health Board.

GPs would be more likely to respond to the prescribing feedback knowing that they would be able to benchmark the performance of their practice against other practices.

GPs would be more likely to respond to the prescribing feedback if they could use the reviews as part of their annual appraisal.