A cluster-randomized educational intervention to reduce inappropriate prescription patterns for elderly patients in general practice – The Prescription Peer Academic Detailing (Rx-PAD) study [NCT00281450]

Straand, Jørúnd; Fetveit, Arne; Rognstad, Sture; Gjelstad, Svein; Brekke, Mette; Dalen, Ingvild

doi:10.1186/1472-6963-6-72

Cited by 38 publications

(49 citation statements)

References 52 publications

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“…The study intervention consisted of an educational package on safer prescribing practice for older patients. 26 The control groups were assigned to another educational intervention targeting antibiotic prescribing practice for respiratory tract infections.…”

Section: Resultsmentioning

confidence: 99%

Prescription peer academic detailing to reduce inappropriate prescribing for older patients: a cluster randomised controlled trial

Rognstad¹,

Brekke²,

Fetveit³

et al. 2013

Br J Gen Pract

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BackgroundOlder patients are at particular risk for adverse drug reactions. In older people, interventions targeting potentially inappropriate prescriptions (PIPs) are considered important measures to minimise drug-related harm, especially in the general practice setting where most prescriptions for older patients are issued. AimTo study the effects of a multifaceted educational intervention on GPs' PIPs for older patients. Design and settingThis was a cluster randomised, educational intervention study in Norwegian general practice. Pre-study data were captured from January 2005 MethodEighty continuing medical education (CME) groups (465 GPs) were randomised to receive the educational intervention on GPs' PIPs for older patients (41 CME groups; 256 GPs) or another educational intervention (39 CME groups; 209 GPs); these two groups acted as controls for each other. GPs' prescription data from before and after the intervention were assessed against a list of 13 explicit PIP criteria for patients aged ≥70 years. In the CME groups, trained GPs carried out an educational programme, including an audit, focusing on the 13 criteria and their rationale. ResultsA total of 449 GPs (96.6%) completed the study; 250 in the intervention group and 199 in the control group. After adjusting for baseline differences and clustering effects, a reduction relative to baseline of 10.3% (95% confidence interval = 5.9 to 15.0) PIPs per 100 patients aged ≥70 years was obtained. ConclusionEducational outreach visits with feedback and audit, using GPs as academic detailers in GPs' CME groups, reduced PIPs for older patients aged ≥70 years in general practice.

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Section: Resultsmentioning

confidence: 99%

Prescription peer academic detailing to reduce inappropriate prescribing for older patients: a cluster randomised controlled trial

Rognstad¹,

Brekke²,

Fetveit³

et al. 2013

Br J Gen Pract

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“…[19][20][21] Reaching these goals by regulatory or other interventions in BZD-Z in the elderly shows variable results. [22][23][24][25] However, there are substantial differences between the health systems in the countries. In Norway the general practitioner scheme which defines a regular physician for each patient and hence continuity in the treatment, provides a good possibility to a close follow up of the BZD-Z users.…”

Section: Discussionmentioning

confidence: 99%

“…In Norway the general practitioner scheme which defines a regular physician for each patient and hence continuity in the treatment, provides a good possibility to a close follow up of the BZD-Z users. 25,26 A third option is to re-evaluate the guidelines and the purpose of guidelines. Studies have shown that, on the whole, BZD-Z are effective and remarkably safe drugs.…”

Section: Discussionmentioning

confidence: 99%

Benzodiazepine and z-hypnotic use in Norwegian elderly, aged 65-79

Berg¹

2012

Nor J Epidemiol

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Purpose: Benzodiazepines/z-hypnotics (BZD-Z) guidelines suggest that elderly people ought to use anxiolytic benzodiazepines (BZD) and z-hypnotics only at low dose and only for a short time, and that hypnotic BZD not should be used at all. Since the elderly aged 65-79 tend to be recently retired but still in relatively good health, they may have different needs for BZD-Z than those older or younger. Our objective is to examine BZD-Z use in this age group. Methods: The study population consisted of Norwegians, aged 65-79, who filled prescriptions for anxiolytic BZD, hypnotic BZD and/or z-hypnotics in [2004][2005][2006][2007][2008][2009]. The quantities prescribed were in daily defined doses (DDD), and 100 DDD/year was deemed excessive. Results: More than a quarter of the population received at least one BZD-Z prescription each year. Half of those received more than 100 DDD/year and a quarter received over 250 DDD/year, with these proportions increasing year by year. All three subgroups of BZD-Z showed increasing use with age and all except anxiolytic BZD showed increasing proportions of users using more than 100 DDD/year with age. Conclusions: Substantial numbers of elderly aged 65-79 receive prescriptions for BZD-Z, more with increasing age, and greater amounts per user. Guidelines are clearly ignored. While a rigid enforcement of guidelines/rules is not the answer, allowing the status quo to continue shows lack of respect for guidelines.

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“…9,25,26 A limited number of Our results are consistent with 2 randomized controlled trials published since the start of the OPTI-SCRIPT study in finding a multifaceted intervention to be effective. 13,14 In the Rx-PAD study, Rognstad et al 14 and Straand et al 29 found peer academic detailing, delivered at continuing medical education meetings, with mailed prescriber feedback, produced a 10% (95% CI, 5.9%-15.0%) reduction in PIP. Bregnhøj et al 13 found interactive educational meetings and feedback resulted in a 5-point (95% CI, 7.3-to 2.6-point) improvement in the medication appropriateness index score.…”

Section: Main Findingsmentioning

confidence: 99%

Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study)

Clyne

Smith

Hughes³

et al. 2015

The Annals of Family Medicine

152

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PURPOSE Potentially inappropriate prescribing (PIP) is common in older people and can result in increased morbidity, adverse drug events, and hospitalizations. The OPTI-SCRIPT study (Optimizing Prescribing for Older People in Primary Care, a cluster-randomized controlled trial) tested the effectiveness of a multifaceted intervention for reducing PIP in primary care. METHODSWe conducted a cluster-randomized controlled trial among 21 general practitioner practices and 196 patients with PIP. Intervention participants received a complex, multifaceted intervention incorporating academic detailing; review of medicines 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. We performed intention-to-treat analysis using random-effects regression.RESULTS All 21 practices and 190 patients were followed. At intervention completion, patients in the intervention group had significantly lower odds of having PIP than patients in the control group (adjusted odds ratio = 0.32; 95% CI, 0.15-0.70; P = .02). The mean number of PIP drugs in the intervention group was 0.70, compared with 1.18 in the control group (P = .02). The intervention group was almost one-third less likely than the control group to have PIP drugs at intervention completion, but this difference was not significant (incidence rate ratio = 0.71; 95% CI, 0.50-1.02; P = .49). The intervention was effective in reducing proton pump inhibitor prescribing (adjusted odds ratio = 0.30; 95% CI, 0.14-0.68; P = .04). CONCLUSIONSThe OPTI-SCRIPT intervention incorporating academic detailing with a pharmacist, and a review of medicines with web-based pharmaceutical treatment algorithms, was effective in reducing PIP, particularly in modifying prescribing of proton pump inhibitors, the most commonly occurring PIP drugs nationally.

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A cluster-randomized educational intervention to reduce inappropriate prescription patterns for elderly patients in general practice – The Prescription Peer Academic Detailing (Rx-PAD) study [NCT00281450]

Cited by 38 publications

References 52 publications

Prescription peer academic detailing to reduce inappropriate prescribing for older patients: a cluster randomised controlled trial

Prescription peer academic detailing to reduce inappropriate prescribing for older patients: a cluster randomised controlled trial

Benzodiazepine and z-hypnotic use in Norwegian elderly, aged 65-79

Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study)

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