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- Title
Potentially Inappropriate Prescribing to Older Patients: Criteria, Prevalence and an Intervention to Reduce It: The Prescription Peer Academic Detailing (Rx‐PAD) Study – A Cluster‐Randomized, Educational Intervention in Norwegian General Practice
- Authors
Rognstad, Sture; Brekke, Mette; Gjelstad, Svein; Straand, Jørund; Fetveit, Arne
- Abstract
Abstract: Potentially inappropriate prescriptions (PIP) is drug treatment, which in general, at the group level for a median/mean patient, can be considered unfavourable meaning that the risks commonly may outweigh the benefits. This MiniReview reports and discusses the main findings in a large cluster‐randomized educational intervention in Norwegian general practice, aimed at reducing the prevalence of PIPs to patients ≥70 years (The Rx‐PAD study). Targets for the intervention were general practitioners (GPs) in continuing medical education (CME) groups receiving educational outreach visits (i.e. peer academic detailing). A Delphi consensus process, with a panel of medical experts, was undertaken to elaborate a list of explicit criteria defining PIPs for patients ≥70 years in general practice. Agreement was achieved for 36 explicit PIP criteria, the so‐called Norwegian General Practice (NorGeP) criteria. Using a selection (n = 24) of these criteria during a 1‐year baseline period on the prescribing practice of 454 GPs (i.e. those enrolled to participate in the intervention trial), we found a prevalence rate of 24.7 PIPs per 100 patients ≥70 years per year. In the Rx‐PAD study, 449 GPs completed an educational intervention (96.6% of the included GPs), 250 in the intervention group and 199 in the control arm. Following the intervention, PIPs were reduced by 13% (95% CI 8.6–17.3), and the number of patients who were no longer exposed to one or more PIPs was reduced by 1173 (8.1%). The GPs who responded most strongly to the educational intervention were the oldest GPs (57–68 years), and these were the GPs with the highest prevalence of PIPs at baseline before the intervention.
- Subjects
FAMILY medicine; PRIMARY care; INAPPROPRIATE prescribing (Medicine); MULTIPLE criteria decision making; POLYPHARMACY
- Publication
Basic & Clinical Pharmacology & Toxicology, 2018, Vol 123, Issue 4, p380
- ISSN
1742-7835
- Publication type
Article
- DOI
10.1111/bcpt.13040