Intervention Leads to Reduction in Number of Risky Drug Prescriptions

From 2011 to 2012, researchers in Scotland conducted a randomized trial to determine whether a three-pronged approach to reducing the instances of risky prescription practices would be effective. The results of this study, which was funded by the Scottish Government Chief Scientist Office, were recently published in The New England Journal of Medicine: Safer Prescribing — A Trial of Education, Informatics, and Financial Incentives.

The research team, headed by Dr. Tobias Dreischulte, Ph.D., recognized that high-risk prescribing and preventable drug-related complications occur frequently in primary care, and they were determined to assess whether complex intervention could improve these outcomes.

Some examples of high-risk prescribing practices, as cited by Diana Swift ofMedscape in her article, Risky Drug Prescriptions Cut by Multipronged Intervention, include the over-prescription of antiplatelet agents and nonsteroidal anti-inflammatory drugs (NSAIDs), the prescription of NSAIDs for patients with chronic kidney disease or heart failure, and co-prescription of NSAID and oral anticoagulants without gastric protection.

For the purposes of the study, the research team approached 34 random primary care practices in Tayside, Scotland, with an intervention that came in three parts:

• professional education in the form of a one-hour educational visit from a physician and follow-up newsletters;
• the supply of informatics to facilitate patient chart review; and
• financial incentives for these practices to review prescription practices to determine their appropriateness.  These incentives were approximately $600 per practice paid in increments of $25 for each patient chart reviewed.

Swift reports on the outcomes: “The rate of continuing high-risk prescribing dropped from 2.6% just before the intervention to 1.5% afterward (adjusted odds ratio, 0.60; 95% CI, 0.53 - 0.67; P < .001), whereas new high-risk prescribing decreased from 1.1% to 0.7% (adjusted odds ratio, 0.77; 95% CI, 0.68 - 0.87; P < .001).” 

The research team concluded that these intervention practices were effective and improved patient outcomes.

You can learn more about this study by reading the article at Medscape here, or by reading the actual report as published in the New England Journal of Medicine here.