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