title: Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study).
abstract: OBJECTIVE
  Potentially inappropriate prescribing (PIP) is common in older people and can result in increased morbidity, adverse drug events, and hospitalizations. The OPTI-SCRIPT study (Optimizing Prescribing for Older People in Primary Care, a cluster-randomized controlled trial) tested the effectiveness of a multifaceted intervention for reducing PIP in primary care.
  
  
  METHODS
  We conducted a cluster-randomized controlled trial among 21 general practitioner practices and 196 patients with PIP. Intervention participants received a complex, multifaceted intervention incorporating academic detailing; review of medicines with web-based pharmaceutical treatment algorithms that provide recommended alternative-treatment options; and tailored patient information leaflets. Control practices delivered usual care and received simple, patient-level PIP feedback. Primary outcomes were the proportion of patients with PIP and the mean number of potentially inappropriate prescriptions. We performed intention-to-treat analysis using random-effects regression.
  
  
  RESULTS
  All 21 practices and 190 patients were followed. At intervention completion, patients in the intervention group had significantly lower odds of having PIP than patients in the control group (adjusted odds ratio = 0.32; 95% CI, 0.15-0.70; P = .02). The mean number of PIP drugs in the intervention group was 0.70, compared with 1.18 in the control group (P = .02). The intervention group was almost one-third less likely than the control group to have PIP drugs at intervention completion, but this difference was not significant (incidence rate ratio = 0.71; 95% CI, 0.50-1.02; P = .49). The intervention was effective in reducing proton pump inhibitor prescribing (adjusted odds ratio = 0.30; 95% CI, 0.14-0.68; P = .04).
  
  
  CONCLUSIONS
  The OPTI-SCRIPT intervention incorporating academic detailing with a pharmacist, and a review of medicines with web-based pharmaceutical treatment algorithms, was effective in reducing PIP, particularly in modifying prescribing of proton pump inhibitors, the most commonly occurring PIP drugs nationally.
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Republic of Ireland barbaraclyne@rcsi.ie.
authors.forename: Barbara
authors.initials: B
authors.lastname: Clyne
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Republic of Ireland.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Smith
authors.affiliation: School of Pharmacy, Queen's University Belfast (QUB), Belfast, Northern Ireland.
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hughes
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Republic of Ireland.
authors.forename: Fiona
authors.initials: F
authors.lastname: Boland
authors.affiliation: National Cancer Institute, Rockville, Maryland.
authors.forename: Marie C
authors.initials: MC
authors.lastname: Bradley
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Republic of Ireland School of Pharmacy, Queen's University Belfast (QUB), Belfast, Northern Ireland.
authors.forename: Janine A
authors.initials: JA
authors.lastname: Cooper
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
mesh_terms: D000368:Aged; D000465:Algorithms; D016000:Cluster Analysis; D003695:Delivery of Health Care / Q000379:methods*; D004360:Drug Therapy, Computer-Assisted / Q000379:methods*; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000706:statistics & numerical data; D007494:Ireland; D008297:Male; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*; D015397:Program Evaluation; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D012044:Regression Analysis
chemical_list: D054328:Proton Pump Inhibitors
keywords: potentially inappropriate prescribing; practice-based research; prescription drugs; primary health care; randomized controlled trial