Improving prescribing in patients with reduced creatinine clearance: a feedback intervention feasibility study

Su Wood, University of Leeds

This study will test whether it is possible to provide feedback to GP Surgeries on their prescribing for older people with low kidney function.  


Kidneys work more slowly as we get older. Reduced kidney function is normal for older people, but it can lead to problems. Many medicines are removed from the body by the kidneys. If kidney function is low, some medicines can stay in the blood for longer, causing harm and even hospital treatment. 

The NHS has prescribing recommendations to reduce the dose, or to avoid certain medicines, if the patient’s kidney function is low, measured by ‘creatinine clearance’. Our previous research has found that it is difficult for prescribers to know which medicines need to be considered, and how to apply the recommendations when prescribing or doing a medication review. 

‘Feedback’ gives information about how well or how badly someone is doing something, and is intended to help them do it better. Feedback reports to GP Practices have been used to provide information on prescribing safety. For example, feedback reports on long term opioid prescribing for non-cancer pain (which is harmful) have been successful in reducing the number of patients prescribed opioids. We want to find out if we can run a similar process for prescribing when kidney function is reduced. 


We will explore: 

  • whether we can get the information we need to tell GP Surgeries about their prescribing compared to others. 
  • the delivery of feedback reports to the people who would need to see them, including GPs, nurses and pharmacists,  
  • what happens to the reports at the Surgery, what people think of them, and any changes made.  


We plan to recruit GP Surgeries from two Primary Care Networks. The study has three phases: 

  1. Development of prescribing feedback reports to include, for example, prescribing recommendations, up-to-date evidence on harm, how to assess kidney function for prescribing. Three reports will be delivered every two months, each focussing on one area of high prescribing risk. 
  1. Collection of anonymous data on how kidney function is assessed when prescribing decisions are being made – five times over eleven months. This is to measure change over time, and to inform practices in the feedback reports. (no patient data will be seen by the study team). 
  1. Observe how the reports are received in Surgeries, and how they are used. For example, sitting in on a meeting where they are discussed. Staff will be interviewed to explore their views on the process and experience of receiving the feedback reports. 

The findings from this study will help us decide whether feedback on prescribing for patients with low kidney function should be tested in a bigger trial. The study findings will be shared through local patient, healthcare and university groups, presentations, papers and via social media. 

The abstract is available to view here and the final report is available here.