Abstract
BackgroundPotentially inappropriate prescribing (PIP) in older people is common in primary care and can result in increased morbidity, adverse drug events, hospitalizations and mortality. The prevalence of PIP in Ireland is estimated at 36% with an associated expenditure of over €45 million in 2007. The aim of this paper is to describe the application of the Medical Research Council (MRC) framework to the development of an intervention to decrease PIP in Irish primary care.MethodsThe MRC framework for the design and evaluation of complex interventions guided the development of the study intervention. In the development stage, literature was reviewed and combined with information obtained from experts in the field using a consensus based methodology and patient cases to define the main components of the intervention. In the pilot stage, five GPs tested the proposed intervention. Qualitative interviews were conducted with the GPs to inform the development and implementation of the intervention for the main randomised controlled trial.ResultsThe literature review identified PIP criteria for inclusion in the study and two initial intervention components - academic detailing and medicines review supported by therapeutic treatment algorithms. Through patient case studies and a focus group with a group of 8 GPs, these components were refined and a third component of the intervention identified - patient information leaflets. The intervention was tested in a pilot study. In total, eight medicine reviews were conducted across five GP practices. These reviews addressed ten instances of PIP, nine of which were addressed in the form of either a dose reduction or a discontinuation of a targeted medication. Qualitative interviews highlighted that GPs were receptive to the intervention but patient preference and time needed both to prepare for and conduct the medicines review, emerged as potential barriers. Findings from the pilot study allowed further refinement to produce the finalised intervention of academic detailing with a pharmacist, medicines review with web-based therapeutic treatment algorithms and tailored patient information leaflets.ConclusionsThe MRC framework was used in the development of the OPTI-SCRIPT intervention to decrease the level of PIP in primary care in Ireland. Its application ensured that the intervention was developed using the best available evidence, was acceptable to GPs and feasible to deliver in the clinical setting. The effectiveness of this intervention is currently being tested in a pragmatic cluster randomised controlled trial.Trial registrationCurrent controlled trials ISRCTN41694007
Highlights
Inappropriate prescribing (PIP) in older people is common in primary care and can result in increased morbidity, adverse drug events, hospitalizations and mortality
Potentially inappropriate prescribing (PIP) is a term used to describe a number of suboptimal prescribing practices, the use of medicines that introduce a greater risk of adverse drug-related events where a safer, as effective alternative is available to treat the same condition [1]
The aim of this paper is to describe the application of the early stages of the Medical Research Council (MRC) framework to the development of a multifaceted intervention aimed at reducing PIP in Irish primary care
Summary
Inappropriate prescribing (PIP) in older people is common in primary care and can result in increased morbidity, adverse drug events, hospitalizations and mortality. The prevalence of PIP in Ireland is estimated at 36% with an associated expenditure of over €45 million in 2007. PIP is common in older people and can result in increased morbidity, adverse drug events, hospitalizations and mortality [2,3,4]. Using a recently developed explicit process measure, the Screening Tool of Older People’s Prescriptions (STOPP) criteria, the prevalence of PIP in older people (aged ≥ 70 years) in Ireland has been estimated at 36%, associated with an expenditure of over €45 million in 2007 (or 9% of expenditure on pharmaceuticals in that age group) [5]. The clinical and economic burden of PIP is an important public health concern and it is important to minimize PIP where possible to increase patient safety and encourage costeffective prescribing behaviour
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