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Table 2 Summary of the active and less active components of the DQIP intervention

From: Process evaluation of the data-driven quality improvement in primary care (DQIP) trial: active and less active ingredients of a multi-component complex intervention to reduce high-risk primary care prescribing

Intervention component and subcomponents Research team’s rationale(s) for including this component (TIDieR item 2) Participant’s perceptions and/or use of the intervention components
Financial incentives
In general Attract practices to participate Important for recruitment as symbolised recognition of the additional work required of GPs and generated extra income.
Up-front payment Increase practice commitment to doing the work as already accepted some payment Had a limited role in mediating effectiveness.
Payment per completed review Ensure reach is maximised and work is maintained over trial duration Practices said the financial incentive did not change what they did but two failing practices said had they known about the financial incentive they may have done more.
Education
Branding DQIP patient safety Motivate GPs by appealing to their professional values Important for recruitment as most GPs felt they could not ignore this topic.
Prescribing advice Avoid inertia Had an important role in mediating effectiveness because GPs valued clear and concise prescribing advice and were able to action decisions quickly.
Structured written educational material reinforcing EOV Support and reinforce the educational messages delivered in the EOV No perceived role in effectiveness. Two GPs used the one page laminated sheet when communicating with patients. Otherwise, this material was not referred to.
Educational outreach visit Persuade the GPs that the prescribing mattered and encourage GPs to perceive this as new and necessary work which required immediate attention Had a limited role in mediating effectiveness because already persuaded GPs said they did not find the messages ‘new’, and the already less convinced GPs were not always persuaded that this was a problem worthwhile addressing.
Discussion about potential process to do the work. Motivate GPs to commence review immediately. Had an important role in large practices for identifying an appropriate process and defining roles and responsibilities.
Newsletters Aimed to encourage continued reviewing activity. Encouraged non-reviewers to revisit tool. Reviewers liked seeing their high risk prescribing going down.
Informatics
Identification of patients to review Mobilise GPs to review by reducing administrative burden (at the time of the trial this was a labour intensive process primarily conducted by pharmacists and administrative staff). Important for implementing change as GPs valued the tool’s simple case finding ability and did not question its accuracy.
Structured clinical information to facilitate review Facilitate efficient reviews by providing relevant information (reviewing was time consuming as involved reading patient’s notes to identify relevant information). Important for effectiveness as GPs legitimised and valued the relevant and accurate data; however, all GPs continued to consult patient’s clinical notes.
Record review decisions Record data important for the trial and process evaluation. Some GPs found the requirement to ensure all relevant information was addressed irritating.
Run charts of change in prescribing Motivate GPs to continue reviewing by comparison to previous performance Had a limited role mediating effectiveness because GPs were not generally motivated by this in the web-based tool, although the same run charts were motivating for some when sent in newsletters.