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Open Access Research article

Addressing potentially inappropriate prescribing in older patients: development and pilot study of an intervention in primary care (the OPTI-SCRIPT study)

Barbara Clyne1*, Marie C Bradley2, Carmel M Hughes2, Daniel Clear1, Ronan McDonnell1, David Williams3, Tom Fahey1, Susan M Smith1 and on behalf of the OPTI-SCRIPT study team

Author Affiliations

1 HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland (RCSI), Beaux Lane House, Lower Mercer Street, Dublin, Ireland

2 School of Pharmacy, Queen’s University Belfast (QUB), University Road, BT7 1NN, Belfast, Northern Ireland

3 Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Beaumont Road, Dublin, Ireland

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BMC Health Services Research 2013, 13:307  doi:10.1186/1472-6963-13-307

Published: 14 August 2013

Abstract

Background

Potentially inappropriate prescribing (PIP) in older people is common in primary care and can result in increased morbidity, adverse drug events, hospitalizations and mortality. The prevalence of PIP in Ireland is estimated at 36% with an associated expenditure of over €45 million in 2007. The aim of this paper is to describe the application of the Medical Research Council (MRC) framework to the development of an intervention to decrease PIP in Irish primary care.

Methods

The MRC framework for the design and evaluation of complex interventions guided the development of the study intervention. In the development stage, literature was reviewed and combined with information obtained from experts in the field using a consensus based methodology and patient cases to define the main components of the intervention. In the pilot stage, five GPs tested the proposed intervention. Qualitative interviews were conducted with the GPs to inform the development and implementation of the intervention for the main randomised controlled trial.

Results

The literature review identified PIP criteria for inclusion in the study and two initial intervention components - academic detailing and medicines review supported by therapeutic treatment algorithms. Through patient case studies and a focus group with a group of 8 GPs, these components were refined and a third component of the intervention identified - patient information leaflets. The intervention was tested in a pilot study. In total, eight medicine reviews were conducted across five GP practices. These reviews addressed ten instances of PIP, nine of which were addressed in the form of either a dose reduction or a discontinuation of a targeted medication. Qualitative interviews highlighted that GPs were receptive to the intervention but patient preference and time needed both to prepare for and conduct the medicines review, emerged as potential barriers. Findings from the pilot study allowed further refinement to produce the finalised intervention of academic detailing with a pharmacist, medicines review with web-based therapeutic treatment algorithms and tailored patient information leaflets.

Conclusions

The MRC framework was used in the development of the OPTI-SCRIPT intervention to decrease the level of PIP in primary care in Ireland. Its application ensured that the intervention was developed using the best available evidence, was acceptable to GPs and feasible to deliver in the clinical setting. The effectiveness of this intervention is currently being tested in a pragmatic cluster randomised controlled trial.

Trial registration

Current controlled trials ISRCTN41694007

Keywords:
Medical research council framework; Multifaceted intervention; Potentially inappropriate prescribing; Randomised controlled trial