Audit and feedback for reducing long-term prescribing of benzodiazepines and opioids by general practitioners

INTERVENTION: Brief name: Audit and feedback and printed educational materials General practices in the same Australian postcode and remoteness area (RA), containing general practitioners (GPs) and other medical practitioners (OMPs) will be simultaneously randomised to no intervention control or to one of four intervention groups at baseline. Purpose of the intervention(s): To reduce long‐term prescribing of benzodiazepines and/or opioids by Australian GPs and OMPs Procedures: Written audit and feedback with or without printed educational materials (PEM) sent to Australian GPs and OMPs Materials: Audit and feedback letter and PEM to facilitate prescribers to identify long‐term use of benzodiazepines and/or opioids in their patient cohort and support GPs and OMPs to reduce long‐term prescribing. The PEM related to benzodiazepine prescribing will provide prescribers with conversation starters to initiate a discussion with their patients about reducing long‐term benzodiazepine use and a tapering algorithm to guide benzodiazepine tapering. Similar PEM related to opioid prescribing will be used ‐ i.e. conversation starters for prescribers to initiate a discussion with their patients about reducing long term opioid use and a tapering algorithm to guide opioid tapering. Provider: NPS MedicineWise Mode of delivery: Mailed to the majority of participants at their nominated mailing address. A small proportion of participants ( 1000‐1500) have opted to receive an electronic version of the materials via their nominated email address. Tailoring: Audit and feedback on long‐term benzodiazepine and opioid prescribing individualised to the recipient. PEM not tailored to individual recipients Fidelity: Return to sender documented 6 to 12 months and >12 to 18 months post opioid intervention delivery. Assessed using PBS data.[0 to 6 months, >6 to 12 months, and >12 to 18 months after opioid intervention delivery.] Overall rate of targeted benzodiazepine prescriptions by each recipient that are dispensed for patients aged 65 years or older by a pharmacist per 1000 consultations over the following periods: 0 to 6 months, >6 to 12 months, and >12 to 18 months post benzodiazepine intervention delivery. Assessed using PBS data.[0 to 6 months, >6 to 12 months, and >12 to 18 months after benzodiazepine intervention delivery.] Overall rate of targeted benzodiazepine prescriptions for each recipient per 1000 consultations that are dispensed by a pharmacist over the following periods: 0 to 6 months, >6 to 12 months and >12 to 18 months post benzodiazepine intervention delivery (where time 0 is date of intervention delivery). Assessed using PBS data.[0 to 6 months, >6 to 12 months, and >12 to 18 months after benzodiazepine intervention delivery.] Percentage of patients aged 65 years or older prescribed a targeted benzodiazepine by each recipient who received 4 or more prescriptions of any of the targeted benzodiazepines that are dispensed by a pharmacist over the following periods: 0 to 6 months, >6 to 12 months, and >12 to 18 months post benzodiazepine intervention delivery. Assessed using PBS data.[0 to 6 months, >6 to 12 months, and >12 to 18 months after benzodiazepine intervention delivery.] Percentage of patients prescribed a targeted benzodiazepine by each recipient who received 4 or more prescriptions of any of the targeted benzodiazepines that are dispensed by a pharmacist over the following periods: 0 to 6 months, >6 to 12 months, and >12 to 18 months post benzodiazepine intervention delivery. Assessed using PBS data.[0 to 6 months, >6 to 12 months, and >12 to 18 months after benzodiazepine intervention delivery.] Percentage of patients prescribed a targeted opioid by each recipient who were prescribed 7 or more prescriptions of any of the targeted opioids that are dispensed by a pharmacist over the following periods: 0 to 6 months, >6 to 12 months, and >12 to 18 months post opioid intervention delivery. Assessed using PBS data.[0 to 6 months, >6 to 12 months, and >12 to 18 months after opioid intervention delivery. ] Percentage of patients prescribed both 1 or more prescriptions of any targeted benzodiazepine and 1 or more prescriptions of any targeted opioid by each recipient that are dispensed by a pharmacist over the following periods: 0 to 6 months, >6 to 12 months, and >12 to 18 months post opioid intervention delivery. Assessed using PBS data.[0 to 6 months, >6 to 12 months, and >12 to 18 months after opioid intervention delivery. ] Proportion of all opioid prescriptions that are prescribed and dispensed as buprenorphine fentanyl or transdermal patches over the following periods: 0 to 6 months, >6 to 12 months, and >12 to 18 months post opioid intervention delivery. Assessed using PBS data.[0 to 6 months, >6 to 12 months, and >12 to 18 months after opioid intervention delivery.] Rate of gabapentinoid prescriptions for each recipient per 1000 consultations that are dispensed by a pharmacist (calculated subject to data availability) over the following periods: 0 to 6 months, >6 to 12 months, and >12 to 18 months post opioid intervention delivery. Assessed using PBS data.[0 to 6 months, >6 to 12 months, and >12 to 18 months after opioid intervention delivery. ]