A Quality Use of Medicines program for general practitioners and older people: A cluster randomised controlled trial

Sabrina W. Pit, Julie E. Byles, David A. Henry, Lucy Holt, Vibeke Hansen, Deborah A. Bowman

Research output: Contribution to journalArticleResearchpeer-review

87 Citations (Scopus)

Abstract

Objective: To investigate the effectiveness of an educational Quality Use of Medicines program, delivered at the level of general practice, on medicines use, falls and quality of life in people aged ≥ 65 years. Design: Cluster randomised controlled trial conducted in 2002. Setting: General practices in the Hunter Region, New South Wales, Australia. Participants: Twenty general practitioners recruited 849 patients to participate in the study. Intervention: Education (academic detailing, provision of prescribing information and feedback); medication risk assessment; facilitation of medication review; financial incentives. Main outcome measures: Primary measures: a composite score reflecting use of benzodiazepines, non-steroidal anti-inflammatory drugs (NSAIDs) and thiazide diuretics; secondary measures: use of medication reviews, occurrence of falls, quality of life (as assessed by SF-12 and EQ-5D survey scores. Results: Compared with the control group, participants in the intervention group had increased odds of having an improved medication use composite score (odds ratio [OR], 1.86; 95% Cl, 1.21-2.85) at 4-month follow-up but not at 12 months. At 4-month follow-up, the intervention group had reduced odds of using NSAIDs (OR, 0.62; 95% Cl, 0.39-0.99) and showed a non-significant reduction in use of benzodiazepines (OR, 0.51; 95% Cl, 0.20-1.30) and thiazide diuretics (OR, 0.70; 95% Cl, 0.48-1.01). Changes in drug use were not significant at 12-month follow-up. At 12 months, intervention-group participants had lower adjusted ORs (AORs) for having a fall (AOR, 0.61; 95% Cl, 0.41-0.91), injury (AOR, 0.56; 95% Cl, 0.32-0.96), and injury requiring medical attention (AOR, 0.46; 95% Cl, 0.30-0.70). Quality-of-life scores were unaffected by the intervention. Conclusion: Education and systems for medication review conducted by GPs can be used to improve use of medicines. These interventions are associated with a reduction in falls among older people, without adverse effects on quality of life.

Original languageEnglish
Pages (from-to)23-30
Number of pages8
JournalMedical Journal of Australia
Volume187
Issue number1
Publication statusPublished - 2 Jul 2007
Externally publishedYes

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General Practitioners
Randomized Controlled Trials
Odds Ratio
Quality of Life
Sodium Chloride Symporter Inhibitors
Benzodiazepines
General Practice
Anti-Inflammatory Agents
Medication Systems
Pharmaceutical Preparations
Education
South Australia
New South Wales
Wounds and Injuries
Motivation
Medicine
Outcome Assessment (Health Care)
Control Groups

Cite this

Pit, Sabrina W. ; Byles, Julie E. ; Henry, David A. ; Holt, Lucy ; Hansen, Vibeke ; Bowman, Deborah A. / A Quality Use of Medicines program for general practitioners and older people : A cluster randomised controlled trial. In: Medical Journal of Australia. 2007 ; Vol. 187, No. 1. pp. 23-30.
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abstract = "Objective: To investigate the effectiveness of an educational Quality Use of Medicines program, delivered at the level of general practice, on medicines use, falls and quality of life in people aged ≥ 65 years. Design: Cluster randomised controlled trial conducted in 2002. Setting: General practices in the Hunter Region, New South Wales, Australia. Participants: Twenty general practitioners recruited 849 patients to participate in the study. Intervention: Education (academic detailing, provision of prescribing information and feedback); medication risk assessment; facilitation of medication review; financial incentives. Main outcome measures: Primary measures: a composite score reflecting use of benzodiazepines, non-steroidal anti-inflammatory drugs (NSAIDs) and thiazide diuretics; secondary measures: use of medication reviews, occurrence of falls, quality of life (as assessed by SF-12 and EQ-5D survey scores. Results: Compared with the control group, participants in the intervention group had increased odds of having an improved medication use composite score (odds ratio [OR], 1.86; 95{\%} Cl, 1.21-2.85) at 4-month follow-up but not at 12 months. At 4-month follow-up, the intervention group had reduced odds of using NSAIDs (OR, 0.62; 95{\%} Cl, 0.39-0.99) and showed a non-significant reduction in use of benzodiazepines (OR, 0.51; 95{\%} Cl, 0.20-1.30) and thiazide diuretics (OR, 0.70; 95{\%} Cl, 0.48-1.01). Changes in drug use were not significant at 12-month follow-up. At 12 months, intervention-group participants had lower adjusted ORs (AORs) for having a fall (AOR, 0.61; 95{\%} Cl, 0.41-0.91), injury (AOR, 0.56; 95{\%} Cl, 0.32-0.96), and injury requiring medical attention (AOR, 0.46; 95{\%} Cl, 0.30-0.70). Quality-of-life scores were unaffected by the intervention. Conclusion: Education and systems for medication review conducted by GPs can be used to improve use of medicines. These interventions are associated with a reduction in falls among older people, without adverse effects on quality of life.",
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A Quality Use of Medicines program for general practitioners and older people : A cluster randomised controlled trial. / Pit, Sabrina W.; Byles, Julie E.; Henry, David A.; Holt, Lucy; Hansen, Vibeke; Bowman, Deborah A.

In: Medical Journal of Australia, Vol. 187, No. 1, 02.07.2007, p. 23-30.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - A Quality Use of Medicines program for general practitioners and older people

T2 - A cluster randomised controlled trial

AU - Pit, Sabrina W.

AU - Byles, Julie E.

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AU - Holt, Lucy

AU - Hansen, Vibeke

AU - Bowman, Deborah A.

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N2 - Objective: To investigate the effectiveness of an educational Quality Use of Medicines program, delivered at the level of general practice, on medicines use, falls and quality of life in people aged ≥ 65 years. Design: Cluster randomised controlled trial conducted in 2002. Setting: General practices in the Hunter Region, New South Wales, Australia. Participants: Twenty general practitioners recruited 849 patients to participate in the study. Intervention: Education (academic detailing, provision of prescribing information and feedback); medication risk assessment; facilitation of medication review; financial incentives. Main outcome measures: Primary measures: a composite score reflecting use of benzodiazepines, non-steroidal anti-inflammatory drugs (NSAIDs) and thiazide diuretics; secondary measures: use of medication reviews, occurrence of falls, quality of life (as assessed by SF-12 and EQ-5D survey scores. Results: Compared with the control group, participants in the intervention group had increased odds of having an improved medication use composite score (odds ratio [OR], 1.86; 95% Cl, 1.21-2.85) at 4-month follow-up but not at 12 months. At 4-month follow-up, the intervention group had reduced odds of using NSAIDs (OR, 0.62; 95% Cl, 0.39-0.99) and showed a non-significant reduction in use of benzodiazepines (OR, 0.51; 95% Cl, 0.20-1.30) and thiazide diuretics (OR, 0.70; 95% Cl, 0.48-1.01). Changes in drug use were not significant at 12-month follow-up. At 12 months, intervention-group participants had lower adjusted ORs (AORs) for having a fall (AOR, 0.61; 95% Cl, 0.41-0.91), injury (AOR, 0.56; 95% Cl, 0.32-0.96), and injury requiring medical attention (AOR, 0.46; 95% Cl, 0.30-0.70). Quality-of-life scores were unaffected by the intervention. Conclusion: Education and systems for medication review conducted by GPs can be used to improve use of medicines. These interventions are associated with a reduction in falls among older people, without adverse effects on quality of life.

AB - Objective: To investigate the effectiveness of an educational Quality Use of Medicines program, delivered at the level of general practice, on medicines use, falls and quality of life in people aged ≥ 65 years. Design: Cluster randomised controlled trial conducted in 2002. Setting: General practices in the Hunter Region, New South Wales, Australia. Participants: Twenty general practitioners recruited 849 patients to participate in the study. Intervention: Education (academic detailing, provision of prescribing information and feedback); medication risk assessment; facilitation of medication review; financial incentives. Main outcome measures: Primary measures: a composite score reflecting use of benzodiazepines, non-steroidal anti-inflammatory drugs (NSAIDs) and thiazide diuretics; secondary measures: use of medication reviews, occurrence of falls, quality of life (as assessed by SF-12 and EQ-5D survey scores. Results: Compared with the control group, participants in the intervention group had increased odds of having an improved medication use composite score (odds ratio [OR], 1.86; 95% Cl, 1.21-2.85) at 4-month follow-up but not at 12 months. At 4-month follow-up, the intervention group had reduced odds of using NSAIDs (OR, 0.62; 95% Cl, 0.39-0.99) and showed a non-significant reduction in use of benzodiazepines (OR, 0.51; 95% Cl, 0.20-1.30) and thiazide diuretics (OR, 0.70; 95% Cl, 0.48-1.01). Changes in drug use were not significant at 12-month follow-up. At 12 months, intervention-group participants had lower adjusted ORs (AORs) for having a fall (AOR, 0.61; 95% Cl, 0.41-0.91), injury (AOR, 0.56; 95% Cl, 0.32-0.96), and injury requiring medical attention (AOR, 0.46; 95% Cl, 0.30-0.70). Quality-of-life scores were unaffected by the intervention. Conclusion: Education and systems for medication review conducted by GPs can be used to improve use of medicines. These interventions are associated with a reduction in falls among older people, without adverse effects on quality of life.

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