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Educational intervention on medication reviews aiming to reduce acute healthcare consumption in elderly patients with potentially inappropriate medicines—A pragmatic open‐label cluster‐randomized controlled trial in primary care
Author(s) -
SchmidtMende K.,
Andersen M.,
Wettermark B.,
Hasselström J.
Publication year - 2017
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.4263
Subject(s) - medicine , randomized controlled trial , intervention (counseling) , context (archaeology) , emergency department , academic detailing , outreach , health care , cluster randomised controlled trial , cluster (spacecraft) , emergency medicine , family medicine , nursing , paleontology , economic growth , political science , computer science , law , economics , biology , programming language
Purpose Potentially inappropriate medicines (PIMs) may cause 10% of unplanned admissions in elderly people. We performed an educational intervention in primary care to reduce acute health care consumption and PIMs through the promotion of medication reviews (MRs) in elderly patients. Methods This cluster‐randomized controlled trial was conducted in the context of an official campaign promoting rational drug use in elderly people. Sixty‐nine primary health care practices with 119,910 patients aged older than or equal to 65 were randomized, with 1 dropout in the intervention group. The intervention consisted of educational outreach visits with feedback on prescribing and the development of a working procedure on MRs. Follow‐up was 9 months. Outcomes were assessed in an administrative health care database. The combined primary outcome was unplanned hospital admission and/or emergency department visit. Secondary outcomes were among other PIMs and rates of MRs. The risk differences in outcomes between intervention and control group were estimated by using regression models. Results During follow‐up, 22.8% of patients in the intervention and 22.0% in the control group were admitted unplanned to hospital and/or experienced at least 1 emergency department (nonsignificant risk difference 0.8%, 95% CI −0.7% to 2.4%). There were no significant differences regarding secondary outcomes such as PIMs or MRs. Conclusions No changes were seen in acute health care consumption, PIMs, and MRs in elderly patients after an educational intervention in primary care. The reasons for the lack of effect could be a suboptimal intervention, limitations in outcome measures, and the use of administrative data to monitor outcomes.