Instances of potentially inappropriate prescribing (PIP) in older people in primary care Not Applicable
Conditions
Interventions
Practices will be assigned to intervention or control using minimization to ensure balance between the groups in terms of practice size (number of whole-time-equivalent GPs) and practice location (urb
Sponsors
The Health Research Board - Centre for Primary Care Research (Ireland)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: GP practices: 1. Have approximately 80 or more older patients (aged = 70 years) on their patient panel Patients: 1. Aged 70 years or above 2. They are being prescribed one or more selected potentially inappropriate prescribing (PIP) drugs on a repeat basis (only patients with existing PIP will be included as the intervention is specifically targeting PIP management).
Exclusion criteria
Exclusion criteria: GP practices: 1. Involved in the development and piloting of the intervention or other concurrent medication quality related studies Patients: 1. Have significant mental or physical illness which is likely to impair their ability to participate in the study or their ability to give informed consent 2. They are unable to attend the GP surgery for consultation (e.g., nursing home resident) 3. They are participating in another medication quality related study
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1. Proportion of patients with a PIP (composite measure i.e. any number of the study PIPs) 2. Mean number of PIPs per patient | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Drug-specific outcomes: 1.1. The absolute number of PIPs per patient of the top five occurring PIP drugs: 1.1.1. Proton pump inhibitor (PPI) for peptic ulcer disease at full therapeutic dosage for >8 weeks 1.1.2. Long-term use of non-steroidal anti-inflammatory drug (NSAID) (>3 months) for relief of mild joint pain in osteoarthritis 1.1.3. Long-term (i.e. >1 month), long-acting benzodiazepines e.g. chlordiazepoxide, fluazepam, nitrazepam, chlorazepate and benzodiazepines with long-acting metabolites e.g. diazepam 1.1.4. Any regular duplicate drug class prescription 1.1.5. Tricyclic antidepressants (TCAs) with an opiate or calcium channel blocker 1.2. Mean number of PIPs per patient of the top five PIP drugs (as above) 2. Process evaluation measures: 2.1. Number of times alternatives were prescribed 2.2. Decisions made per PIP 2.3. Reported primary reason for decision made e.g. risks outweigh benefits, patient preference, hospital/consultant initiated 3. Patient-reported outcomes: 3.1. Quality of Life (as measured using EQ-5D) 3.2. Patients? medication beliefs (as measured using the Beliefs About Medicines Questionnaire, BMQ) 3.3. Well-being (as measured by the Well-Being Questionnaire, WBQ-12) 4. Process of care measures: 4.1. Number of GP visits 4.2. Number of hospital admissions | — |
Countries
Ireland
Outcome results
None listed