Email updates

Keep up to date with the latest news and content from BMC Health Services Research and BioMed Central.

Open Access Research article

Bridging evidence-practice gaps: improving use of medicines in elderly Australian veterans

Elizabeth E Roughead1, Lisa M Kalisch Ellett1*, Emmae N Ramsay2, Nicole L Pratt2, John D Barratt1, Vanessa T LeBlanc1, Philip Ryan2, Robert Peck3, Graeme Killer3 and Andrew L Gilbert1

Author Affiliations

1 Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia, Adelaide, Australia

2 Data Management and Analysis Centre, Discipline of Public Health, University of Adelaide, Adelaide, Australia

3 Department of Veterans’ Affairs, Canberra, Australia

For all author emails, please log on.

BMC Health Services Research 2013, 13:514  doi:10.1186/1472-6963-13-514

Published: 12 December 2013

Abstract

Background

The Australian Government Department of Veterans’ Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and related health services, which implements interventions that include audit and feedback in the form of patient-specific feedback generated from administrative claims records. We aimed to determine changes in medicine use as a result of the program.

Methods

The program provides targeted patient-specific feedback to medical practitioners. The feedback is supported with educational material developed by a clinical panel, subject to peer review and overseen by a national editorial committee. Veterans who meet target criteria also receive educational brochures. The program is supported by a national call centre and ongoing national consultation. Segmented regression analyses (interrupted time series) were undertaken to assess changes in medication use in targeted veterans pre and post each intervention.

Results

12 interventions were included; three to increase medicine use, seven which aimed to reduce use, and two which had combination of messages to change use. All programs that aimed to increase medicine use were effective, with relative effect sizes at the time of the intervention ranging from 1% to 8%. Mixed results were seen with programs aiming to reduce inappropriate medicine use. Highly specific programs were effective, with relative effect sizes at the time of the intervention of 10% decline in use of NSAIDs in high risk groups and 14% decline in use of antipsychotics in dementia. Interventions targeting combinations of medicines, including medicine interactions and potentially inappropriate medicines in the elderly did not change practice significantly. Interventions with combinations of messages targeting multiple components of practice had an impact on one component, but not all components targeted.

Conclusions

The Veterans’ MATES program showed positive practice change over time, with interventions increasing use of appropriate medicines where under-use was evident and reduced use of inappropriate medicines when single medicines were targeted. Combinations of messages were less effective, suggesting specific messages focusing on single medicines are required to maximise effect. The program provides a model that could be replicated in other settings.

Keywords:
Health promotion; Quality improvement; Quality use of medicines; Translational research; Clinical audit; Evidence-based practice