Audit and feedback interventions involving pharmacists to influence prescribing behaviour in general practice: a systematic review and meta-analysis

Mary Carter* (Corresponding Author), Nouf Abutheraa, Noah Ivers, Jeremy Grimshaw, Sarah Chapman, Philip Rogers, Michelle Simeoni, Jesmin Antony, Margaret C Watson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


INTRODUCTION: Pharmacists, as experts in medicines, are increasingly employed in general practices and undertake a range of responsibilities. Audit and feedback (A&F) interventions are effective in achieving behaviour change, including prescribing. The extent of pharmacist involvement in A&F interventions to influence prescribing is unknown. This review aimed to assess the effectiveness of A&F interventions involving pharmacists on prescribing in general practice compared with no A&F/usual care and to describe features of A&F interventions and pharmacist characteristics.

METHODS: Electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, (Social) Science Citation Indexes, ISI Web of Science) were searched (2012, 2019, 2020). Cochrane systematic review methods were applied to trial identification, selection, and risk of bias. Results were summarized descriptively and heterogeneity was assessed. A random-effects meta-analysis was conducted where studies were sufficiently homogenous in design and outcome.

RESULTS: Eleven cluster-randomized studies from 9 countries were included. Risk of bias across most domains was low. Interventions focussed on older patients, specific clinical area(s), or specific medications. Meta-analysis of 6 studies showed improved prescribing outcomes (pooled risk ratio: 0.78, 95% confidence interval: 0.64-0.94). Interventions including both verbal and written feedback or computerized decision support for prescribers were more effective. Pharmacists who received study-specific training, provided ongoing support to prescribers or reviewed prescribing for individual patients, contributed to more effective interventions.

CONCLUSIONS: A&F interventions involving pharmacists can lead to small improvements in evidence-based prescribing in general practice settings. Future implementation of A&F within general practice should compare different ways of involving pharmacists to determine how to optimize effectiveness.PRISMA-compliant abstract included in Supplementary Material 1.

Original languageEnglish
Article numbercmac150
Pages (from-to)1-14
Number of pages14
JournalFamily Practice
Early online date12 Jan 2023
Publication statusE-pub ahead of print - 12 Jan 2023

Bibliographical note

We would like to thank Associate Professor Denise O’Connor and members of the A&F Systematic Review Risk of Bias team (Dr Jia Xi, Dr Sheila Cyril, and Associate Professor Ashley Fletcher) for their contribution to Risk of Bias assessments for this review.

This work is supported by a PhD Studentship (reference 189447056) awarded to the lead author (MC) by the University of Bath.

Data Availability Statement

Data are available on reasonable request.


  • evidence
  • general practice
  • pharmacist
  • prescribing
  • primary care
  • systematic review


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