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 (>or=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.
RCT Entities:
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 (>or=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.
Authors: Jerry H Gurwitz; Terry S Field; Leslie R Harrold; Jeffrey Rothschild; Kristin Debellis; Andrew C Seger; Cynthia Cadoret; Leslie S Fish; Lawrence Garber; Michael Kelleher; David W Bates Journal: JAMA Date: 2003-03-05 Impact factor: 56.272
Authors: Penkarn Kanjanarat; Almut G Winterstein; Thomas E Johns; Randy C Hatton; Ricardo Gonzalez-Rothi; Richard Segal Journal: Am J Health Syst Pharm Date: 2003-09-01 Impact factor: 2.637
Authors: K Schmader; J T Hanlon; M Weinberger; P B Landsman; G P Samsa; I Lewis; K Uttech; H J Cohen; J R Feussner Journal: J Am Geriatr Soc Date: 1994-12 Impact factor: 5.562
Authors: Tim Johansson; Muna E Abuzahra; Sophie Keller; Eva Mann; Barbara Faller; Christina Sommerauer; Jennifer Höck; Christin Löffler; Anna Köchling; Jochen Schuler; Maria Flamm; Andreas Sönnichsen Journal: Br J Clin Pharmacol Date: 2016-05-07 Impact factor: 4.335
Authors: Meldon Kahan; Tara Gomes; David N Juurlink; Michael Manno; Lynn Wilson; Angela Mailis-Gagnon; Anita Srivastava; Rhoda Reardon; Irfan A Dhalla; Muhammad M Mamdani Journal: Can Fam Physician Date: 2013-05 Impact factor: 3.275
Authors: Amanda J Cross; Johnson George; Michael C Woodward; David Ames; Henry Brodaty; Jenni Ilomäki; Rohan A Elliott Journal: Drugs Aging Date: 2016-01 Impact factor: 3.923