Potentially Inappropriate Prescribing to Older Patients: Criteria, Prevalence and an Intervention to Reduce It: The Prescription Peer Academic Detailing ( Rx‐ PAD ) Study – A Cluster‐Randomized, Educational Intervention in Norwegian General Practice

Potentially inappropriate prescriptions ( PIP ) is drug treatment, which in general, at the group level for a median/mean patient, can be considered unfavourable meaning that the risks commonly may outweigh the benefits. This MiniReview reports and discusses the main findings in a large cluster‐randomized educational intervention in Norwegian general practice, aimed at reducing the prevalence of PIP s to patients ≥70 years (The Rx‐ PAD study). Targets for the intervention were general practitioners ( GP s) in continuing medical education ( CME ) groups receiving educational outreach visits (i.e. peer academic detailing). A Delphi consensus process, with a panel of medical experts, was undertaken to elaborate a list of explicit criteria defining PIP s for patients ≥70 years in general practice. Agreement was achieved for 36 explicit PIP criteria, the so‐called Norwegian General Practice (NorGeP) criteria. Using a selection (n = 24) of these criteria during a 1‐year baseline period on the prescribing practice of 454 GP s (i.e. those enrolled to participate in the intervention trial), we found a prevalence rate of 24.7 PIP s per 100 patients ≥ 70 years per year. In the Rx ‐ PAD study, 449 GP s completed an educational intervention (96.6% of the included GP s), 250 in the intervention group and 199 in the control arm. Following the intervention, PIP s were reduced by 13% (95% CI 8.6–17.3), and the number of patients who were no longer exposed to one or more PIP s was reduced by 1173 (8.1%). The GP s who responded most strongly to the educational intervention were the oldest GP s (57–68 years), and these were the GP s with the highest prevalence of PIP s at baseline before the intervention.