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- Title
Sustained effectiveness of a multifaceted intervention to reduce potentially inappropriate prescribing in older patients in primary care (OPTI-SCRIPT study).
- Authors
Clyne, Barbara; Smith, Susan M.; Hughes, Carmel M.; Boland, Fiona; Cooper, Janine A.; Fahey, Tom; OPTI-SCRIPT study team
- Abstract
<bold>Background: </bold>Potentially 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).<bold>Objective: </bold>We sought to determine whether the improvement in PIP in the short term was sustained at 1-year follow-up.<bold>Methods: </bold>A 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.<bold>Results: </bold>All 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).<bold>Conclusion: </bold>The 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.<bold>Trial Registration: </bold>Current controlled trials ISRCTN41694007 .
- Subjects
IRELAND; PRIMARY health care; OLDER patients; DRUG side effects; DRUG prescribing; RANDOMIZED controlled trials; CLUSTER analysis (Statistics); COMPARATIVE studies; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; RESEARCH; EVALUATION research; EVALUATION of human services programs; INAPPROPRIATE prescribing (Medicine); PREVENTION
- Publication
Implementation Science, 2016, Vol 11, Issue 1, p1
- ISSN
1748-5908
- Publication type
journal article
- DOI
10.1186/s13012-016-0442-2