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BMC Primary Care
Published in: BMC Primary Care 1/2012

Open Access 01-12-2012 | Research article

How to improve drug dosing for patients with renal impairment in primary care - a cluster-randomized controlled trial

Authors: Antje Erler, Martin Beyer, Juliana J Petersen, Kristina Saal, Thomas Rath, Justine Rochon, Walter E Haefeli, Ferdinand M Gerlach

Published in: BMC Primary Care | Issue 1/2012

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Abstract

Background

Patients with chronic kidney disease (CKD) are at increased risk for inappropriate or potentially harmful prescribing. The aim of this study was to examine whether a multifaceted intervention including the use of a software programme for the estimation of creatinine clearance and recommendation of individual dosage requirements may improve correct dosage adjustment of relevant medications for patients with CKD in primary care.

Methods

A cluster-randomized controlled trial was conducted between January and December 2007 in small primary care practices in Germany. Practices were randomly allocated to intervention or control groups. In each practice, we included patients with known CKD and elderly patients (≥70 years) suffering from hypertension. The practices in the intervention group received interactive training and were provided a software programme to assist with individual dose adjustment. The control group performed usual care. Data were collected at baseline and at 6 months. The outcome measures, analyzed across individual patients, included prescriptions exceeding recommended maximum daily doses, with the primary outcome being prescriptions exceeding recommended standard daily doses by more than 30%.

Results

Data from 44 general practitioners and 404 patients are included. The intervention was effective in reducing prescriptions exceeding the maximum daily dose per patients, with a trend in reducing prescriptions exceeding the standard daily dose by more than 30%.

Conclusions

A multifaceted intervention including the use of a software program effectively reduced inappropriately high doses of renally excreted medications in patients with CKD in the setting of small primary care practices.

Trial registration

Current Controlled Trials ISRCTN02900734
Appendix
Available only for authorised users
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Metadata
Title
How to improve drug dosing for patients with renal impairment in primary care - a cluster-randomized controlled trial
Authors
Antje Erler
Martin Beyer
Juliana J Petersen
Kristina Saal
Thomas Rath
Justine Rochon
Walter E Haefeli
Ferdinand M Gerlach
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2012
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-13-91

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