一项多方面干预措施在初级保健中减少老年患者潜在不适当处方的持续有效性（OPTI-SCRIPT研究）。
Sustained effectiveness of a multifaceted intervention to reduce potentially inappropriate prescribing in older patients in primary care (OPTI-SCRIPT study).
作者信息
Clyne Barbara, Smith Susan M, Hughes Carmel M, Boland Fiona, Cooper Janine A, Fahey Tom
机构信息
HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephens Green, Dublin 2, Republic of Ireland.
School of Pharmacy, Queen's University Belfast (QUB), 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.
出版信息
Implement Sci. 2016 Jun 2;11(1):79. doi: 10.1186/s13012-016-0442-2.
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 .
背景
在基层医疗中，潜在不适当处方（PIP）在老年人中很常见，可能导致发病率增加、药物不良事件和住院率上升。我们之前在一项整群随机对照试验（RCT）中证明了多方面干预措施在降低基层医疗中PIP方面的成功。
目的
我们试图确定PIP在短期内的改善在1年随访时是否得以维持。
方法
在爱尔兰基层医疗中，对21家全科医生诊所和196名患有PIP的患者（年龄≥70岁）进行了整群随机对照试验。干预组参与者接受了一项复杂的多方面干预措施，包括学术指导、使用基于网络的药物治疗算法进行药物审查以提供推荐的替代治疗方案，以及量身定制的患者信息手册。对照组诊所提供常规护理，并收到简单的患者层面的PIP反馈。主要结局是1年随访时患有PIP的患者比例和潜在不适当处方的平均数量。采用随机效应回归进行意向性分析。
结果
对所有21家全科医生诊所和186名（95%）患者进行了随访。我们发现，在1年随访时，干预期间实现的PIP暴露几率的显著降低在干预措施停止后得以维持（调整后的比值比为0.28，95%置信区间为0.11至0.76，P = 0.01）。与对照组相比，干预组参与者使用潜在不适当质子泵抑制剂的几率显著更低（调整后的比值比为0.40，95%置信区间为0.17至0.94，P = 0.04）。
结论
干预期间实现的PIP几率的显著降低在干预措施停止后得以维持。这些结果表明，处方质量的改善可以随着时间的推移而保持。
试验注册
当前受控试验ISRCTN41694007 。
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