Abstract
BackgroundPotentially inappropriate prescribing (PIP) is common in older people in primary care and can result in increased morbidity, adverse drug events and hospitalisations. We previously demonstrated the success of a multifaceted intervention in decreasing PIP in primary care in a cluster randomised controlled trial (RCT).ObjectiveWe sought to determine whether the improvement in PIP in the short term was sustained at 1-year follow-up.MethodsA cluster RCT was conducted with 21 GP practices and 196 patients (aged ≥70) with PIP in Irish primary care. Intervention participants received a complex multifaceted intervention incorporating academic detailing, medicine review with web-based pharmaceutical treatment algorithms that provide recommended alternative treatment options, and tailored patient information leaflets. Control practices delivered usual care and received simple, patient-level PIP feedback. Primary outcomes were the proportion of patients with PIP and the mean number of potentially inappropriate prescriptions at 1-year follow-up. Intention-to-treat analysis using random effects regression was used.ResultsAll 21 GP practices and 186 (95 %) patients were followed up. We found that at 1-year follow-up, the significant reduction in the odds of PIP exposure achieved during the intervention was sustained after its discontinuation (adjusted OR 0.28, 95 % CI 0.11 to 0.76, P = 0.01). Intervention participants had significantly lower odds of having a potentially inappropriate proton pump inhibitor compared to controls (adjusted OR 0.40, 95 % CI 0.17 to 0.94, P = 0.04).ConclusionThe significant reduction in the odds of PIP achieved during the intervention was sustained after its discontinuation. These results indicate that improvements in prescribing quality can be maintained over time.Trial registrationCurrent controlled trials ISRCTN41694007.
Highlights
Medication use in older people can improve wellbeing and quality of life; drug-related problems such as medication errors and adverse drug events (ADEs) are common [1]
We have previously demonstrated that a multifaceted intervention was effective in decreasing Potentially inappropriate prescribing (PIP) in older patients in primary care using a short-term followup, on intervention completion at 4–6 months [13]
Intervention participants had significantly lower odds of having a potentially inappropriate proton pump inhibitor compared to controls
Summary
A cluster randomised controlled trial (RCT) was conducted in Irish primary care to alter general practitioner (GP) PIP-related prescribing. Medicine reviews were supported by web-based pharmaceutical treatment algorithms for GPs providing evidence-based alternative treatment options to PIP drugs and tailored patient information leaflets [15]. Control practices received simple patient-level PIP postal feedback in the form of a list summarising the medication class to which the individual patient’s potentially inappropriate medication belonged. The proportion of patients with PIP is presented and was analysed using a random effects logistic regression with the individual as the unit of analysis and the practice included as the random effect to control for the effects of clustering. Secondary outcomes assessed differences between intervention and control in relation to individual drugs (using random effects logistic regressions) and health service utilisation including the number of GP visits and in-patient days (using random effects multiple regressions)
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