Abstract
Purpose
To evaluate the effect of a combined or a single educational intervention on the prescribing behaviour of general practitioners (GPs). The primary endpoint was effect on inappropriate prescribing according to the Medication Appropriateness Index (MAI).
Methods
General practitioners were randomised to either (1) a combined intervention consisting of an interactive educational meeting plus feedback on participating patients’ medication, (2) a single intervention with an interactive educational meeting or (3) a control group (no intervention). Elderly (>65 years) patients exposed to polypharmacy (≥5 medications) were identified and approached for inclusion. Data on medications prescribed over a 3-month period were collected, and the GPs provided detailed information on their patients before and after the intervention. A pre- and post-MAI were scored for all medications.
Results
Of the 277 GPs invited to participate; 41 (14.8%) volunteered. Data were obtained from 166 patients before and after the intervention. Medication appropriateness improved in the combined intervention group but not in the single intervention group. The mean change in MAI and number of medications was −5 [95% confidence interval (CI) −7.3 to −2.6] and −1.03 (95% CI −1.7 to −0.30) in the combined intervention group compared with the group with the educational meeting only and the no intervention group.
Conclusions
A combined intervention consisting of an interactive educational meeting plus recommendations given by clinical pharmacologists/pharmacists concerning specific patients can improve the appropriateness of prescribing among elderly patients exposed to polypharmacy. This study adds to the limited number of well-controlled, randomised studies on overall medication appropriateness among elderly patients in primary care. Important limitations to the study include variability in data provided by participating GPs and a low number of GPs volunteering for the study.
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Ethics approval
Due to an exception to the ‘Act on Patients’ legal rights and entitlements in Denmark’, the Danish National Board of Health instead of the ethics committee approved the protocol.
Funding
This study was financially supported by the Hørslev Foundation, The Danish Research Foundation for General Practice, The Health Insurance Foundation, and The Copenhagen County Health Administration. All of the researchers contributing to this manuscript are independent of the funders.
Conflict of interest
None.
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Additional information
The trial is not registered in a publicly available database of clinical trials. The trial was conducted in a period prior to June 1, 2007.
Appendix
Appendix
In rating the Medication Appropriateness Index, weights of 3 were given to inappropriate ratings for indication and effectiveness, 2 for dosage, direction correctness, drug-–rug interactions and drug–disease interactions and 1 for direction practicality, therapeutic duplication, duration and cost. The weighted MAI score can range from 0, which indicates no prescribing problems, to 18 if all criteria are rated as inappropriate. A score of 0 was given for all criteria rated as appropriate or marginally appropriate. For more information on the MAI, other references should be consulted [31–33].
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Bregnhøj, L., Thirstrup, S., Kristensen, M.B. et al. Combined intervention programme reduces inappropriate prescribing in elderly patients exposed to polypharmacy in primary care. Eur J Clin Pharmacol 65, 199–207 (2009). https://doi.org/10.1007/s00228-008-0558-7
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DOI: https://doi.org/10.1007/s00228-008-0558-7