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Implementation Science
Published in: Implementation Science 1/2015

Open Access 01-12-2015 | Short report

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

Authors: Barbara Clyne, Susan M. Smith, Carmel M. Hughes, Fiona Boland, Janine A. Cooper, Tom Fahey, on behalf of the OPTI-SCRIPT study team

Published in: Implementation Science | Issue 1/2015

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Abstract

Background

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).

Objective

We sought to determine whether the improvement in PIP in the short term was sustained at 1-year follow-up.

Methods

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.

Results

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).

Conclusion

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.

Trial registration

Current controlled trials ISRCTN41694007.
Appendix
Available only for authorised users
Literature
1.
Hanlon JT, Schmader KE, Semla TP. Update of studies on drug-related problems in older adults. J Am Geriatr Soc. 2013;61(8):1365–8.CrossRefPubMed
2.
Spinewine A, Schmader K, Barber N, Hughes C, Lapane K, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370:173–84.CrossRefPubMed
3.
Gallagher P, Barry P, O’Mahony D. Inappropriate prescribing in the elderly. J Clin Pharm Ther. 2007;32(2):113–21.CrossRefPubMed
4.
Cahir C, Fahey T, Teeling M, Teljeur C, Feely J, Bennett K. Potentially inappropriate prescribing and cost outcomes for older people: a national population study. Br J Clin Pharmacol. 2010;69(5):543–52.CrossRefPubMedPubMedCentral
5.
Opondo D, Eslami S, Visscher S, Rooij S, Verheij R, Korevaar J, et al. Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review. PLoS ONE. 2012;7(8):e43617.CrossRefPubMedPubMedCentral
6.
Hill-Taylor B, Sketris I, Hayden J, Byrne S, O’Sullivan D, Christie R. Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact. J Clin Pharm Ther. 2013;38(5):360–72.CrossRefPubMed
7.
Jano E, Aparasu RR. Healthcare outcomes associated with Beers’ criteria: a systematic review. Ann Pharmacother. 2007;41(3):438–47.CrossRefPubMed
8.
9.
Forsetlund L, Eike M, Gjerberg E, Vist G. Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials. BMC Geriatr. 2011;11(1):16.CrossRefPubMedPubMedCentral
10.
Alldred DP, Raynor DK, Hughes C, Barber N, Chen TF and Spoor P. Interventions to optimise prescribing for older people in care homes. Cochrane Database Syst Rev 2013 Issue 2:Art. No.: CD009095.
11.
Kaur S, Mitchell G, Vitetta L, Roberts MS. Interventions that can reduce inappropriate prescribing in the elderly: a systematic review. Drugs Aging. 2009;26(12):1013–28.CrossRefPubMed
12.
Yourman L, Concato J, Agostini JV. Use of computer decision support interventions to improve medication prescribing in older adults: a systematic review. Am J Geriatr Pharmacother. 2008;6(2):119–29.CrossRefPubMed
13.
Clyne B, Smith SM, Hughes CM, Boland F, Bradley MC, Cooper JA, et al. Effectiveness of a multifaceted intervention for potentially inappropriate prescribing in older patients in primary care: a cluster-randomized controlled trial (OPTI-SCRIPT study). Ann Fam Med. 2015;13(6):545–53.CrossRefPubMedPubMedCentral
14.
van der Linden CM, Kerskes MC, Bijl AM, Maas HA, Egberts AC, Jansen PA. Represcription after adverse drug reaction in the elderly: a descriptive study. Arch Intern Med. 2006;166(15):1666–7.CrossRefPubMed
15.
Clyne B, Bradley M, Hughes C, Clear D, McDonnell R, Williams D, et al. Addressing potentially inappropriate prescribing in older patients: development and pilot study of an intervention in primary care (the OPTI-SCRIPT study). BMC Health Serv Res. 2013;13(1):307.CrossRefPubMedPubMedCentral
16.
Clyne B, Bradley MC, Smith SM, Hughes CM, Motterlini N, Clear D, et al. Effectiveness of medicines review with web-based pharmaceutical treatment algorithms in reducing potentially inappropriate prescribing in older people in primary care: a cluster randomized trial (OPTI-SCRIPT study protocol). Trials. 2013;14(1):72.CrossRefPubMedPubMedCentral
17.
Lopatto J, Keith SW, Del Canale S, Templin M, Maio V. Evaluating sustained quality improvements: long-term effectiveness of a physician-focused intervention to reduce potentially inappropriate medication prescribing in an older population. J Clin Pharm Ther. 2014;39(3):266–71.CrossRefPubMed
18.
Rognstad S, Brekke M, Fetveit A, Dalen I, Straand J. Prescription peer academic detailing to reduce inappropriate prescribing for older patients: a cluster randomised controlled trial. Br J Gen Pract. 2013;63(613):e554–62.CrossRefPubMedPubMedCentral
19.
Redmond P, Grimes T, McDonnell R, Boland F, Hughes C and Fahey T. Interventions for improving medication reconciliation across transitions of care (protocol). Cochrane Database Sys Rev 2013(10):Art. No.: CD010791.
20.
Moriarty F, Hardy C, Bennett K, Smith SM, Fahey T. Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: a repeated cross-sectional study. BMJ Open. 2015;5(9):e008656.CrossRefPubMedPubMedCentral
21.
Wahab M, Nyfort-Hansen K, Kowalski S. Inappropriate prescribing in hospitalised Australian elderly as determined by the STOPP criteria. Int J Clin Pharm. 2012;34(6):855–62.CrossRefPubMed
22.
Kara O, Arik G, Kizilarslanoglu MC, Kilic MK, Varan HD, Sumer F, et al. Potentially inappropriate prescribing according to the STOPP/START criteria for older adults, Aging clinical and experimental research. 2015.
23.
Bradley M, Motterlini N, Padmanabhan S, Cahir C, Williams T, Fahey T, et al. Potentially inappropriate prescribing among older people in the United Kingdom. BMC Geriatr. 2014;14(1):72.CrossRefPubMedPubMedCentral
24.
Hamzat H, Sun H, Ford JC, MacLeod J, Soiza R, Mangoni A. Inappropriate prescribing of proton pump inhibitors in older patients effects of an educational strategy. Drugs Aging. 2012;29(8):681–90.CrossRefPubMed
25.
Reeve E, Andrews JM, Wiese MD, Hendrix I, Roberts MS, Shakib S. Feasibility of a patient-centered deprescribing process to reduce inappropriate use of proton pump inhibitors. Ann Pharmacother. 2015;49(1):29–38.CrossRefPubMed
26.
Wermeling M, Himmel W, Behrens G and Ahrens D. Why do GPs continue inappropriate hospital prescriptions of proton pump inhibitors? A qualitative study. Eur J Gen Pract. 2013;0(0):1–7.
27.
Ivers N, Jamtvedt G, Flottorp S, Young J, Odgaard-Jensen J, French S, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2012; Issue 6:Art. No.: CD000259.
28.
Jones R, Jones R, McCowan C, Montgomery A, Fahey T. The external validity of published randomized controlled trials in primary care. BMC Fam Pract. 2009;10(1):5.CrossRefPubMedPubMedCentral
29.
Gnjidic D, Le Couteur D, Pearson S-A, McLachlan A, Viney R, Hilmer S, et al. High risk prescribing in older adults: prevalence, clinical and economic implications and potential for intervention at the population level. BMC Public Health. 2013;13(1):115.CrossRefPubMedPubMedCentral
30.
Barnett K, McCowan C, Evans JMM, Gillespie ND, Davey PG, Fahey T. Prevalence and outcomes of potentially inappropriate medicines use in the elderly: cohort study stratified by residence in nursing home or in the community. BMJ Qual Saf. 2011;20:275–81.CrossRefPubMed
31.
Guthrie B, McCowan C, Davey P, Simpson CR, Dreischulte T, Barnett K. High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice. BMJ. 2011;342.
Metadata
Title
Sustained effectiveness of a multifaceted intervention to reduce potentially inappropriate prescribing in older patients in primary care (OPTI-SCRIPT study)
Authors
Barbara Clyne
Susan M. Smith
Carmel M. Hughes
Fiona Boland
Janine A. Cooper
Tom Fahey
on behalf of the OPTI-SCRIPT study team
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2015
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-016-0442-2

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