title: How to improve drug dosing for patients with renal impairment in primary care - a cluster-randomized controlled trial.
abstract: BACKGROUND
  Patients with chronic kidney disease (CKD) are at increased risk for inappropriate or potentially harmful prescribing. The aim of this study was to examine whether a multifaceted intervention including the use of a software programme for the estimation of creatinine clearance and recommendation of individual dosage requirements may improve correct dosage adjustment of relevant medications for patients with CKD in primary care.
  
  
  METHODS
  A cluster-randomized controlled trial was conducted between January and December 2007 in small primary care practices in Germany. Practices were randomly allocated to intervention or control groups. In each practice, we included patients with known CKD and elderly patients (≥70 years) suffering from hypertension. The practices in the intervention group received interactive training and were provided a software programme to assist with individual dose adjustment. The control group performed usual care. Data were collected at baseline and at 6 months. The outcome measures, analyzed across individual patients, included prescriptions exceeding recommended maximum daily doses, with the primary outcome being prescriptions exceeding recommended standard daily doses by more than 30%.
  
  
  RESULTS
  Data from 44 general practitioners and 404 patients are included. The intervention was effective in reducing prescriptions exceeding the maximum daily dose per patients, with a trend in reducing prescriptions exceeding the standard daily dose by more than 30%.
  
  
  CONCLUSIONS
  A multifaceted intervention including the use of a software program effectively reduced inappropriately high doses of renally excreted medications in patients with CKD in the setting of small primary care practices.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN02900734.
authors.affiliation: Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany. erler@allgemeinmedizin.uni-frankfurt.de
authors.forename: Antje
authors.initials: A
authors.lastname: Erler
authors.forename: Martin
authors.initials: M
authors.lastname: Beyer
authors.forename: Juliana J
authors.initials: JJ
authors.lastname: Petersen
authors.forename: Kristina
authors.initials: K
authors.lastname: Saal
authors.forename: Thomas
authors.initials: T
authors.lastname: Rath
authors.forename: Justine
authors.initials: J
authors.lastname: Rochon
authors.forename: Walter E
authors.initials: WE
authors.lastname: Haefeli
authors.forename: Ferdinand M
authors.initials: FM
authors.lastname: Gerlach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003658:Decision Making, Computer-Assisted; D054796:Drug Dosage Calculations; D004360:Drug Therapy, Computer-Assisted / Q000379:methods; D005260:Female; D058006:General Practice / Q000193:education*; D005858:Germany; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D055553:Prescription Drugs / Q000008:administration & dosage*; D011320:Primary Health Care / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*
chemical_list: D055553:Prescription Drugs