Combined intervention programme reduces inappropriate prescribing in elderly patients exposed to polypharmacy in primary care

Bregnhøj, Lisbeth; Thirstrup, Steffen; Kristensen, M; Bjerrum, Lars; Sonne, Jesper

doi:10.1007/s00228-008-0558-7

Cited by 67 publications

(94 citation statements)

References 32 publications

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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%

“…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. Differences in effect sizes reported between these studies and the OPTI-SCRIPT findings may arise from a number of factors, including differences in the criteria used to assess PIP, the duration of follow-up, and the included patients.…”

Section: Main Findingsmentioning

confidence: 99%

“…11,12 To date, a limited number of multifaceted interventions have been evaluated in primary care to decrease PIP. 13,14 The purpose of the OPTI-SCRIPT study (Optimizing Prescribing for Older People in Primary Care, a cluster-randomized controlled trial) was to investigate the effectiveness of a multifaceted intervention in reducing PIP in older people in Irish primary care.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Main Findingsmentioning

confidence: 99%

Section: Main Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…Este fenómeno originou um aumento da prevalência das doenças crónicas e do número de indivíduos polimedicados, realidade mais evidente na população idosa. [3][4][5][6][7][8][11][12][13][14][15][16][17][18] A adesão à terapêutica é menor em indivíduos portadores de doenças crónicas devido à necessidade de medicação prolongada 19 e também naqueles com esquemas terapêuticos complexos, isto é, com múltiplos fármacos ou tomas. 3,7,11 Este tipo de esquemas não só diminui a adesão à terapêutica, como também aumenta o risco de erros de medicação; risco todavia maior quando associado às alterações fisiológicas do envelhecimento.…”

Section: Introductionunclassified

“…3,7,11 Este tipo de esquemas não só diminui a adesão à terapêutica, como também aumenta o risco de erros de medicação; risco todavia maior quando associado às alterações fisiológicas do envelhecimento. [4][5][6][11][12][13]15,19 Os sistemas eletrónicos de informação e decisão terapêutica e a informação escrita são fatores que contribuem para minimizar os erros de prescrição e favorecem a adesão à medicação, melhorando a prestação de cuidados e contribuindo para a redução de custos. [3][4][5][6][7][8][9][10] Por tudo o que foi referido, surgiu a necessidade de conhecer a realidade portuguesa em relação ao registo da medicação prolongada, para que se possam implementar medidas para melhorar a prestação de cuidados, minimizar os erros de prescrição e os custos nos cuidados de saúde.…”

Section: Introductionunclassified

Avaliação da Qualidade dos Registos de Medicação Prolongada: Estudo QMP

et al. 2014

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Introduction:The growing concern surrounding health safety issues makes it essential that everyone, in particular the elderly due to their commonly prescribed multiple drugs, has a complete and up to date list of prescriptions. We planned to assess the quality of the electronic records of prolonged medication. Material and Methods:This is an observational, transversal and descriptive study, with an analytical component, in which we assessed the technical quality of prolonged medication records of elderly patients of four primary health care, before and after a guided intervention. The doctors received training in good practice recording methods and both professionals and patients were stimulated to use the prolonged medication guide. Results: We evaluated 388 medical records of 33 physicians. The ideal category 'Appropriated medication with posology' improved from 23.5% to 48% (p < 0,001). The remaining categories 'Inappropriated Medication' and 'Appropriated medication but absent posology' decreased from 16.7% to 7% (p = 0,006) and from 59.8% to 46.0% (p = 0,02), respectively. The variables mentor's training skills, workplace, length of family practice and the percentage of elderly in the physician's list showed statistical significance differences at the beginning of the study which disappeared after the intervention, except for the latter. Discussion: In this study, physicians accepted the proposed changes, regardless of age, gender, mentor's training skills, workplace or length of family practice. Longer duration appointments in the eldery group may be an obstacle in achieving the best results. Conclusion: This original study reveals the necessity to implement periodic postgraduate training to encourage physicians to keep medical records up to date.

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