A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis

Autor: Anthony J Avery, Matthew J. Boyd, Denise Kendrick, Rachel Elliott, Robin J Prescott, Sarah Armstrong, Aziz Sheikh, Koen Putman, Caroline Morris, Judith A. Cantrill, Glen Swanwick, Martin Eden, Rachel Howard, Matthew Franklin, Sarah Rodgers, Kathrin Cresswell
Přispěvatelé: Interuniversity Centre For Health Economics Research
Rok vydání: 2012
Předmět:
medicine.medical_specialty
Peptic Ulcer
Cost-Benefit Analysis
Feedback
Psychological
Adrenergic beta-Antagonists
MEDLINE
Pharmacist
Amiodarone
Angiotensin-Converting Enzyme Inhibitors
Community Pharmacy Services
Pharmacology
Pharmacists
law.invention
Contraceptives
Oral
Hormonal
Patient safety
Electrolytes
Randomized controlled trial
Sodium Potassium Chloride Symporter Inhibitors
law
Antimanic Agents
Intervention (counseling)
patient safety
Medicine
Humans
Medication Errors
Urea
Cluster randomised controlled trial
Medical prescription
Primary Care
business.industry
Contraindications
Anti-Inflammatory Agents
Non-Steroidal
Proton Pump Inhibitors
Articles
Medication error
General Medicine
Cost-effectiveness analysis
Asthma
Methotrexate
England
Drug Information Services
Physical therapy
Lithium Compounds
Regression Analysis
Drug Monitoring
business
Family Practice
Anti-Arrhythmia Agents
Immunosuppressive Agents
Zdroj: Lancet
Europe PubMed Central
ISSN: 1474-547X
Popis: Summary Background Medication errors are common in primary care and are associated with considerable risk of patient harm. We tested whether a pharmacist-led, information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to hazardous prescribing and inadequate blood-test monitoring of medicines 6 months after the intervention. Methods In this pragmatic, cluster randomised trial general practices in the UK were stratified by research site and list size, and randomly assigned by a web-based randomisation service in block sizes of two or four to one of two groups. The practices were allocated to either computer-generated simple feedback for at-risk patients (control) or a pharmacist-led information technology intervention (PINCER), composed of feedback, educational outreach, and dedicated support. The allocation was masked to researchers and statisticians involved in processing and analysing the data. The allocation was not masked to general practices, pharmacists, patients, or researchers who visited practices to extract data. Primary outcomes were the proportions of patients at 6 months after the intervention who had had any of three clinically important errors: non-selective non-steroidal anti-inflammatory drugs (NSAIDs) prescribed to those with a history of peptic ulcer without co-prescription of a proton-pump inhibitor; β blockers prescribed to those with a history of asthma; long-term prescription of angiotensin converting enzyme (ACE) inhibitor or loop diuretics to those 75 years or older without assessment of urea and electrolytes in the preceding 15 months. The cost per error avoided was estimated by incremental cost-effectiveness analysis. This study is registered with Controlled-Trials.com, number ISRCTN21785299. Findings 72 general practices with a combined list size of 480 942 patients were randomised. At 6 months' follow-up, patients in the PINCER group were significantly less likely to have been prescribed a non-selective NSAID if they had a history of peptic ulcer without gastroprotection (OR 0·58, 95% CI 0·38–0·89); a β blocker if they had asthma (0·73, 0·58–0·91); or an ACE inhibitor or loop diuretic without appropriate monitoring (0·51, 0·34–0·78). PINCER has a 95% probability of being cost effective if the decision-maker's ceiling willingness to pay reaches £75 per error avoided at 6 months. Interpretation The PINCER intervention is an effective method for reducing a range of medication errors in general practices with computerised clinical records. Funding Patient Safety Research Portfolio, Department of Health, England.
Databáze: OpenAIRE
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