title: Effectiveness of medicines review with web-based pharmaceutical treatment algorithms in reducing potentially inappropriate prescribing in older people in primary care: a cluster randomized trial (OPTI-SCRIPT study protocol).
abstract: BACKGROUND
  Potentially inappropriate prescribing in older people is common in primary care and can result in increased morbidity, adverse drug events, hospitalizations and mortality. In Ireland, 36% of those aged 70 years or over received at least one potentially inappropriate medication, with an associated expenditure of over €45 million.The main objective of this study is to determine the effectiveness and acceptability of a complex, multifaceted intervention in reducing the level of potentially inappropriate prescribing in primary care.
  
  
  METHODS
  This study is a pragmatic cluster randomized controlled trial, conducted in primary care (OPTI-SCRIPT trial), involving 22 practices (clusters) and 220 patients. Practices will be allocated to intervention or control arms using minimization, with intervention participants receiving a complex multifaceted intervention incorporating academic detailing, medicines review with web-based pharmaceutical treatment algorithms that provide recommended alternative treatment options, and tailored patient information leaflets. Control practices will deliver usual care and receive simple patient-level feedback on potentially inappropriate prescribing. Routinely collected national prescribing data will also be analyzed for nonparticipating practices, acting as a contemporary national control. The primary outcomes are the proportion of participant patients with potentially inappropriate prescribing and the mean number of potentially inappropriate prescriptions per patient. In addition, economic and qualitative evaluations will be conducted.
  
  
  CONCLUSIONS
  This study will establish the effectiveness of a multifaceted intervention in reducing potentially inappropriate prescribing in older people in Irish primary care that is generalizable to countries with similar prescribing challenges.
  
  
  BACKGROUND
  Current controlled trials ISRCTN41694007.
authors.affiliation: Health Research Board, Centre for Primary Care Research, Royal College of Surgeons in Ireland, Beaux Lane House, Lower Mercer Street, Dublin, Ireland. barbaraclyne@rcsi.ie
authors.forename: Barbara
authors.initials: B
authors.lastname: Clyne
authors.forename: Marie C
authors.initials: MC
authors.lastname: Bradley
authors.forename: Susan M
authors.initials: SM
authors.lastname: Smith
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hughes
authors.forename: Nicola
authors.initials: N
authors.lastname: Motterlini
authors.forename: Daniel
authors.initials: D
authors.lastname: Clear
authors.forename: Ronan
authors.initials: R
authors.lastname: McDonnell
authors.forename: David
authors.initials: D
authors.lastname: Williams
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
mesh_terms: D000367:Age Factors; D000368:Aged; D000465:Algorithms; D003365:Costs and Cost Analysis; D004360:Drug Therapy, Computer-Assisted / Q000191:economics; D064420:Drug-Related Side Effects and Adverse Reactions; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006299:Health Services for the Aged / Q000191:economics; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D020407:Internet / Q000191:economics; D007494:Ireland; D059065:Medication Reconciliation / Q000191:economics / Q000379:methods*; D010174:Pamphlets; D010353:Patient Education as Topic; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000191:economics; D012107:Research Design