Changing Outcomes Through Achievement Emails in COPD Using Routine Healthcare Audits

Summary

This study is exploring how to improve prescribing for people with chronic obstructive pulmonary disease (COPD) in primary care. COPD is a long-term lung condition. Guidelines recommend the most effective inhalers for different patient groups, but in practice, some patients still receive treatments that are less effective or no longer recommended.

One proven way to support better prescribing is "audit and feedback." This involves giving GP practices reports showing how their prescribing compares with guidance and with other practices. Audit and feedback can change behaviour, particularly when focused on medicines and when practices have scope to improve.

In West Yorkshire, the NHS Integrated Care Board (ICB) is running a quality improvement project (QIP) to reduce inappropriate prescribing in COPD. Every GP practice already receives regular feedback reports. This study will run within that project.

The research will test whether the type of email sent with these reports influences prescribing. Practices will be randomly assigned to one of two groups:

* Personalised emails: highlighting their own performance, recognising progress, and giving practical suggestions.
* Generic emails: a simple notification that the report is available, with no tailored advice.

All practices will receive the same reports, seven times over one year; only the email wording will differ.

The main outcome will be the change in how many COPD patients are prescribed inhalers that combine a long-acting beta agonist and inhaled corticosteroid (LABA/ICS), which are no longer recommended in COPD. Secondary outcomes will include other COPD prescribing measures identified by a clinical expert panel. The study will also explore factors that might influence effectiveness, such as practice size, deprivation, and COPD caseload.

Data will come from existing NHS sources. The ICB already collects anonymised prescribing data for improvement work. For this study, the data will be pseudonymised so researchers cannot identify practices. The University of Leeds will analyse the results, but the research team will not know which code relates to which practice.

This study will not change patient care directly. All patients will continue with their usual GP treatment. The aim is to understand whether small changes in delivering audit and feedback make it more effective in supporting best prescribing. In the long term, this could improve the safety and quality of COPD care.

Conditions

• COPD (Chronic Obstructive Pulmonary Disease)

Interventions

OTHER

Generic email - control

A generic email delivered to a GP practice alongside a digital feedback report. The generic control email will be the same text each time for all practices within that arm and will contain no suggestions for improving practice.

OTHER

Personalised email - Intervention

A personalised achievement email delivered to a GP practice alongside a digital feedback report. The personalised email wording will change based on the achievement of the practice and the content in the feedback reports, which is being distributed as part of the pre-existing quality improvement project, rather than this research study. The recommendations in bullet points within the personalised emails suggesting how to improve care will be informed as relevant succinct summaries of the key guidance contained with the feedback reports, which will be based on either national guidelines or respected published literature. This will be written by the lead researcher for this project (who is the author of the QIP feedback reports themselves) and will be reviewed by the same group that reviews the QIP feedback report content before publication.

Sponsors & Collaborators

• University of Leeds

  lead OTHER

Principal Investigators

• Owen Thomas, MBBS; MSc · University of Leeds

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

DOUBLE

Model

PARALLEL

Eligibility

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-12-01

Primary Completion

2026-10-01

Completion

2027-01-04

Countries

• United Kingdom

Study Locations