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

Older 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.

AIM:

To study the effects of a multifaceted educational intervention on GPs' PIPs for older patients.

DESIGN AND SETTING:

This was a cluster randomised, educational intervention study in Norwegian general practice. Pre-study data were captured from January 2005 to December 2005 and post-study data from June 2006 to June 2007. The educational intervention was carried out from January 2006 to June 2006.

METHOD:

Eighty 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.

RESULTS:

A 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.

CONCLUSION:

Educational 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.

 

HuisartsengeneeskundeEducational gatheringsFeedbackBehandeling medicatie

 

Auteurs

Rognstad S
Brekke M
Fetveit A
Dalen I
Straand J

 

Link

https://www.ncbi.nlm.nih.gov/pubmed/23972196