Educational interventions delivered to prescribing advisers to influence primary care prescribing: a very low-cost pragmatic randomised trial using routine data from OpenPrescribing.net

Background: NHS England issued commissioning guidance on 18 low-priority treatments which should not be routinely prescribed in primary care. We aimed to monitor the impact of an educational intervention delivered to regional prescribing advisors by senior pharmacists from NHS England on the primary care spend on low-priority items. Methods: An opportunistic randomised, controlled parallel-group trial. Participants (clinical commissioning groups, CCGs) were randomised to intervention or control in a 1:1 ratio. The intervention group were invited to participate. The intervention was a one-off educational session. Our primary outcomes concerned the total prescribing of low-priority items in primary care. Secondary outcomes concerned the prescribing of specific low-priority items. We also measured the impact on information-seeking behaviour. Results: 40 CCGs were randomised, 20 allocated to intervention, with 11 receiving the intervention. There was no significant impact on any prescribing outcomes. There was some possible evidence of increased engagement with data, in the form of CCG email alert sign-ups (p=0.077). No harms were detected. Conclusions: A one-off intervention delivered to CCGs by NHS England did not significantly influence low-priority prescribing. This trial demonstrates how routine interventions planned to improve uptake or adherence to healthcare guidance can be delivered as low-cost randomised trials and how to robustly assess their effectiveness. ### Competing Interest Statement Authors declare the following: BG has received research funding from the Bennett Foundation, the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organisation, UKRI, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme; he also receives personal income from speaking and writing for lay audiences on the misuse of science. BMK and BR work for the NHS and BMK is seconded to the Bennett Institute. RP acknowledges partial support from the NIHR Applied Research Collaboration Oxford & Thames Valley, the NIHR Programme Grants for Applied Research, the NIHR Oxford Medtech and In-Vitro Diagnostics Co-operative and the Oxford Martin School. He also receives payment for editorial work carried out for the BMJ and BMJ Medicine Journals. All other University of Oxford authors are employed on BGs grants. ### Clinical Trial ISRCTN31218900 ### Clinical Protocols ### Funding Statement This work was supported by The NIHR Biomedical Research Centre, Oxford, the Health Foundation (Award Reference Number 7599); National Institute for Health Research (NIHR) School of Primary Care Research (SPCR) (Award Reference Number 327); the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0418-20036) and by the National Institute for Health Research Applied Research Collaboration Oxford and Thames Valley. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS England or the Department of Health and Social Care. Funders had no role in the study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Medical Sciences Interdivisional Research Ethics Committee of the University of Oxford waived ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The dataset(s) supporting the conclusions of this article is(are) available in the low-priority-CCG-visit-RCT repository, https://github.com/ebmdatalab/low-priority-CCG-visit-RCT. This study uses open, publicly available data alongside website/email usage data. Processed data is available within the study repository along with all analysis code.