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Preliminary experiences with a single‐patient trials service in general practice
Author(s) -
Nikles C Jane,
Glasziou Paul P,
Mar Chrls B Del,
Duggan Cate M,
Clavarino Alexandra,
Yelland Michael J
Publication year - 2000
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2000.tb139254.x
Subject(s) - medicine , osteoarthritis , placebo , physical therapy , n of 1 trial , ibuprofen , patient satisfaction , clinical trial , chronic pain , alternative medicine , surgery , pathology , pharmacology
Objective To pilot a single‐patient trials (SPTs) service in general practice, designed to improve decision‐making about long‐term medications for chronic conditions. Design 12‐week within‐patient, randomised, double‐blind, placebo‐controlled, crossover comparison of ibuprofen with paracetamol for osteoarthritis, involving three pairs of two‐week treatment periods for each participating patient. Setting and patients Patients attending an academic general practice with a clinical diagnosis of osteoarthritis, with pain of at least a month's duration severe enough to warrant consideration of long‐term non‐steroidal anti‐inflammatory drug (NSAID) use. Main outcome measures Pain and stiffness; measures of overall arthritis compared with previous fortnight; preference for NSAID at the end of each twoweek treatment period; use of escape analgesia; side effects; and management changes as a result of the SPTs. Results Eight of 14 patients completed SPTs. One was a clear responder to NSAIDs, five were non‐responders, and two were indefinite. Of the five who were using NSAIDs before the SPT, two continued and three ceased using them. Clinically useful information assisted decision‐making for all eight participants. Medication management changed for six. Conclusions Single‐patient trials can be successfully implemented in general practice and might be a valuable method for GPs to identify patients who respond to medication for chronic stable conditions such as osteoarthritis, in which individual response to medication is variable.