Combined intervention programme reduces inappropriate prescribing in elderly patients exposed to polypharmacy in primary care

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. 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.     

基层医疗机构药品流通现状与对策分析

通过对当前基层医疗机构药品流通现状进行分析,深入剖析基层医疗机构药品流通环节存在的问题。提出利用现代化手段,加强基层医疗机构药品流通监管的对策,从而根治药品非法流通,保证基层医疗机构用药安全。     

Deprescribing interventions in primary health care mapped to the Behaviour Change Wheel: A scoping review

BackgroundPolypharmacy and inappropriate medication use are an increasing concern. Deprescribing may improve medication use through planned and supervised dose reduction or stopping of medications. As most medication management occurs in primary health care, which is generally described as the first point of access for day-to-day care, deprescribing in primary health care is the focus on this review.ObjectiveThis scoping review aimed to identify and characterize strategies for deprescribing in primary health care and map the strategies to the Behaviour Change Wheel (BCW).MethodsA scoping review was conducted that involved searches of six databases (2002–2018) and reference lists of relevant systematic reviews and included studies. Studies that described and evaluated deprescribing strategies in primary health care were eligible. Two independent reviewers screened articles and completed data charting with charting verified by a third. Deprescribing strategies were mapped to the intervention functions of the BCW and linked to specific Behaviour Change Techniques (BCT).ResultsSearches yielded 6871 citations of which 43 were included. Nineteen studies were randomized, 24 were non-randomized. Studies evaluated deprescribing in terms of medication changes, feasibility, and prescriber/patient perspectives. Deprescribing strategies involved various professionals (physicians, pharmacists, nurses), as well as patients and were generally multifaceted. A wide range of intervention functions were identified, with 41 BCTs mapped to Environmental restructuring, 38 BCTs mapped to Enablement, and 34 BCTs mapped to Persuasion.ConclusionsDeprescribing strategies in primary health care have used a variety of BCTs to address individual professionals (e.g. education) as well as strategies that addressed the practice setting, including support from additional team members (e.g. pharmacists, nurses and patients). Further research is warranted to determine comparative effectiveness of different BCTs, which can help facilitate implementation of deprescribing strategies, thereby reducing polypharmacy, in primary health care.     

Increased use of second generation antipsychotic drugs in primary care: potential relevance for hospitalizations in schizophrenia patients

Aim

To analyze the changes in the prescribing pattern of antipsychotic drugs in primary care in Extremadura (Spain) from 1990 to 2005, and the potential association with schizophrenia hospitalization rate.

Methods

Data from 1990–2005 about the prescribing of antipsychotic drugs was drawn from all community pharmacy sales figures reimbursed by the Health System of Extremadura. Drug consumption figures were expressed as the number of defined daily doses per 1,000 inhabitants and per day of treatment (DDD/1,000/day). The total number of annual hospital discharges with the diagnosis of schizophrenia according to DSM-IV criteria from all hospitals in Extremadura from 1 January 1995 to 31 December 2000 was also determined.

Results

The use of second-generation antipsychotic drugs (SGAs) increased from 0% in 1990–1993 to 78% in 2005. Olanzapine was the most used SGA from 1999–2005. During 1995–2000 the sales of SGAs increased to 50% from 10%. In the same period, the hospitalization rate in schizophrenia patients fell by an average of 12%, which was significantly associated with SGA use (R?=??0.88; P?=?0.02).

Discussion

The increase in SGAs paralleled the decreased rate of hospitalization in schizophrenia patients. However, the influence of other factors such as SGA use for disorders other than schizophrenia can not be ruled out. Moreover changes in the health-care system, such as the increase in primary mental health care and social rehabilitation programs, may also have a relevant influence.