Educational intervention on medication reviews aiming to reduce acute healthcare consumption in elderly patients with potentially inappropriate medicines:A pragmatic open-label cluster-randomized controlled trial in primary care
| Autor: | K. Schmidt-Mende, Morten Andersen, J. Hasselström, Björn Wettermark |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty pharmacoepidemiology Epidemiology Nurses Context (language use) Inappropriate Prescribing 030204 cardiovascular system & hematology Disease cluster Pharmacists law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Intervention (counseling) Physicians Health care medicine Humans Pharmacology (medical) 030212 general & internal medicine Practice Patterns Physicians' Aged Aged 80 and over Sweden education Education Medical Primary Health Care business.industry Pharmacoepidemiology Absolute risk reduction inappropriate prescribing Emergency department Hospitalization primary health care aged Emergency medicine randomized controlled trial Female business |
| Zdroj: | Schmidt-Mende, K, Andersen, M, Wettermark, B & Hasselström, J 2017, ' Educational intervention on medication reviews aiming to reduce acute healthcare consumption in elderly patients with potentially inappropriate medicines : A pragmatic open-label cluster-randomized controlled trial in primary care ', Pharmacoepidemiology and Drug Safety, vol. 26, no. 11, pp. 1347-1356 . https://doi.org/10.1002/pds.4263 |
| DOI: | 10.1002/pds.4263 |
| Popis: | Purpose Potentially inappropriate medicines (PIMs) may cause 10% of unplanned admissions in elderly people. We performed an educational intervention in primary care to reduce acute health care consumption and PIMs through the promotion of medication reviews (MRs) in elderly patients. Methods This cluster-randomized controlled trial was conducted in the context of an official campaign promoting rational drug use in elderly people. Sixty-nine primary health care practices with 119,910 patients aged older than or equal to 65 were randomized, with 1 dropout in the intervention group. The intervention consisted of educational outreach visits with feedback on prescribing and the development of a working procedure on MRs. Follow-up was 9 months. Outcomes were assessed in an administrative health care database. The combined primary outcome was unplanned hospital admission and/or emergency department visit. Secondary outcomes were among other PIMs and rates of MRs. The risk differences in outcomes between intervention and control group were estimated by using regression models. Results During follow-up, 22.8% of patients in the intervention and 22.0% in the control group were admitted unplanned to hospital and/or experienced at least 1 emergency department (nonsignificant risk difference 0.8%, 95% CI −0.7% to 2.4%). There were no significant differences regarding secondary outcomes such as PIMs or MRs. Conclusions No changes were seen in acute health care consumption, PIMs, and MRs in elderly patients after an educational intervention in primary care. The reasons for the lack of effect could be a suboptimal intervention, limitations in outcome measures, and the use of administrative data to monitor outcomes. KEY POINTS We evaluated the implementation methods of an officially launched campaign to stimulate medication reviews in primary care presupposed by policymakers to be effective. The prevalence of potentially inappropriate medicines was analysed in official registers accounting for an unbiased analysis. No effect of the implementation strategy was detected and reasons for this are discussed. Potential shortcomings of the implementation strategy include; the matter of medication reviews being too complex or the implementation technique being too weak. |
| Databáze: | OpenAIRE |
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