Effectiveness of interactive dashboards to optimise prescribing in primary care: A systematic review

BackgroundThe World Health Organisations Medication Without Harm campaign aims to reduce severe avoidable medication related harm by 50%. This systematic review explored the characteristics of interventions that provide visual and longitudinal feedback on prescribing, or interactive dashboards, in general practice and the effect of these interventions on prescribing-related outcome measures. MethodsThis systematic review was registered prospectively and reported in line with PRISMA guidelines. Multiple databases and grey literature were searched in November 2023 to identify interventional studies that explored the effect of interactive dashboards on prescribing-related outcomes in general practice. Two independent researchers conducted screening, data extraction, and risk of bias assessment. Interventions were described narratively, and a random-effects meta-analysis was performed for comparable studies. ResultsEight randomised controlled trials, one controlled before-and-after study and three interrupted time series were included. Six studies reported a significant positive effect on prescribing-related outcomes, with an effect seen more often for studies focusing on potentially inappropriate prescribing (PIP) (four out of six). Two of the six studies that focused on antibiotic prescribing demonstrated a significant effect. A meta-analysis of three RCTs involving 160 general practices and 198,135 patients demonstrated the overall odds of PIP was 0.91 (95%CI: 0.77-1.06 I2=71.8%) in the intervention compared to control group. ConclusionInteractive dashboards show promise for supporting safe and effective prescribing in general practice. Future research should focus on developing core outcome sets to facilitate future meta-analyses of effectiveness as well as optimising their implementation and understanding how to sustain user engagement. Lay summaryThe World Health Organizations "Medication Without Harm" campaign aims to reduce preventable medication-related harm by 50%. One way to support safe prescribing is by giving prescribers ongoing feedback on their prescribing habits using interactive dashboards. These dashboards provide visual and long-term data to help guide safer and more effective prescribing. This research looked at how interactive dashboards have been used in general practice and whether their use improves prescribing. Researchers systematically searched the published literature and identified 12 relevant studies. Some studies involved randomly assigning doctors or practices to either use the dashboards or continue usual care. Others compared prescribing practices before and after introducing dashboards or looked at practices that used dashboards compared to those that did not. Six of the studies showed improvements in prescribing, especially when focused on reducing high-risk prescriptions. The data for three studies that looked at high-risk prescribing involving 160 general practices and 198,135 patients showed that interactive dashboards may reduce the chance of unsafe prescribing by 8.8%. However, this result was not statistically significant, and the difference in results between studies means the true effect remains uncertain. The findings highlight the potential of interactive dashboards to support safer prescribing in general practice, though further research is needed.