Sustained effectiveness of a multifaceted intervention to reduce potentially inappropriate prescribing in older patients in primary care (OPTI-SCRIPT study)

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.

Deprescribing of proton pump inhibitors in the elderly

“…Исследователи рассчитывали смертность на 100 человеко-лет: самой высокой она оказалась в третьей и четвертой группах: 5,6 (95% ДИ 5,51-5,61) и 5,45 (95% ДИ 5,41-5,49), соответственно. В общей когорте смертность на 100 человеко-лет составила 5,08 (95% ДИ 5,05-5,11), во второй группе -4,40 (95% ДИ 4, 45). Также риск смерти зависел от продолжительности лечения ИПП.…”

“…[28] было включено 21 исследование, в котором изучались результаты депрескрайбинга ИПП у пожилых пациентов ( ≥65 лет). В 6 исследованиях была подтверждена эффективность депрескрайбинга [44][45][46][47][48][49]. По мнению авторов обзора [28], вмешательство будет эффективным, если объяснить пациенту пользу депрескрайбинга и заинтересовать его.…”

“…В трех указанных выше систематических обзорах [35][36][37] представлены 5 рандомизированных контролируемых исследований, в которых изучались результаты депрескрайбинга ИПП у пожилых пациентов [33,36,[44][45][46][47]. В каждом исследовании показана эффективность депрескрайбинга, как на госпитальном уровне [46,47], так и в первичном звене здравоохранения [33,36,44,45].…”

“…В рандомизированном контролируемом исследовании OPTI-SCRIPT [44,45] у пациентов основной группы (n=99) проводили полидепрескрайбинг, в том числе ИПП, а больные контрольной группы (n=97) принимали препараты в соответствии со стандартной практикой. Оценивали частоту применения ИПП в каждой группе через 4-6 мес [44] и 12 мес [45]. В основной группе она снизилась через 6 мес с 53,5% до 23,2%, а в контрольной -с 67,0% до 47,4% (отношение шансов 0,30; 95% ДИ 0,14-0,68; p=0,04).…”

Reducing Potentially Inappropriate Prescribing for Older People in Primary Care: Cost-Effectiveness of the Opti-Script Intervention

“…To this end, a cluster randomized controlled trial (RCT) was conducted to evaluate a multifaceted intervention, incorporating academic detailing with a pharmacist and medicines' review with web-based pharmaceutical treatment algorithms, to reduce potentially inappropriate prescribing among older people (10)(11)(12)(13). In the clinical effectiveness analysis the results indicated that, relative to usual care, the intervention was associated with a significant reduction in PIPs overall, largely driven by modifications to the prescribing of proton pump inhibitors (10,13). In addition to clinical effectiveness, any decision regarding the adoption of healthcare interventions in clinical practice should depend upon their expected cost effectiveness (14).…”