title: Effects of a primary care intervention to improve the quality of zolpidem prescriptions in elderly patients.
abstract: OBJECTIVE
  The objective of this study was to measure the impact of an intervention on the prescription habits of general practitioners (GPs) in order to improve the quality of zolpidem prescriptions in patients aged 75 or older.
  
  
  METHODS
  A prospective multicentric non-randomized trial was performed in the Metropolitan Granada Primary Healthcare Area (Andalusian Public Healthcare Service, Spain), which serves a total population of approximately 675,000 inhabitants. All health centers volunteering to participate in the trial were included. The intervention consisted of training sessions, individualized feedback, clinical information, and financial incentives. A daily dose over 5 mg was considered non-safe. Reduction in non-safe prescriptions of zolpidem in the elderly population became a quality prescribing indicator in a pay-for-performance scheme.
  
  
  RESULTS
  Statistically significant differences versus baseline were found between the intervention and control groups in mean zolpidem prescription prevalence (28.5 vs. 37.5‰, respectively; p = 0.008) and mean non-safe zolpidem prescription prevalence (16.5 vs. 34.2‰, respectively; p < 0.001). At the end of the study period, the total number of non-safe prescriptions was 1309, 35% lower versus baseline, with a significant difference of p < 0.001; the number in the intervention (510 vs. 1118; p < 0.001) and control (799 vs. 893; p = 0.0064) groups was also significantly lower, with a significantly greater percentage reduction in the intervention group (54.4 vs. 10.5%, p < 0.001).
  
  
  CONCLUSIONS
  The quality prescribing indicator in our area was improved by the intervention developed. Further studies that include an intervention group of GPs who receive no financial incentive are required to evaluate the relative importance of an economic reward in achieving this improvement.
authors.affiliation: Unidad Gestión Clínica de Farmacia Provincial de Granada, Distrito Sanitario Granada Metropolitano, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada, Granada, Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: López-Sepúlveda
authors.affiliation: Unidad Gestión Clínica de Farmacia Provincial de Granada, Distrito Sanitario Granada Metropolitano, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada, Granada, Spain. mariaa.garcia.lirola.sspa@juntadeandalucia.es.
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: García Lirola
authors.affiliation: Unidad Gestión Clínica de Farmacia Provincial de Granada, Distrito Sanitario Granada Metropolitano, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada, Granada, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Espínola García
authors.affiliation: Unidad Gestión Clínica de Farmacia Provincial de Granada, Distrito Sanitario Granada Metropolitano, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada, Granada, Spain.
authors.forename: Salvadora
authors.initials: S
authors.lastname: Martín Sances
authors.affiliation: Unidad Gestión Clínica de Farmacia Provincial de Granada, Distrito Sanitario Granada Metropolitano, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada, Granada, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Anaya Ordóñez
authors.affiliation: Unidad Gestión Clínica de Farmacia Provincial de Granada, Distrito Sanitario Granada Metropolitano, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada, Granada, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Jurado Martínez
authors.affiliation: Unidad de Gestión Clínica de Farmacia Provincial de Granada, Complejo Hospitalario de Granada, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada., Granada, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Cabeza Barrera
mesh_terms: D000368:Aged; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D011320:Primary Health Care; D011446:Prospective Studies; D011725:Pyridines / Q000627:therapeutic use*; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem
keywords: Elderly; General practitioners; Physician incentive plans; Physician’s practice pattern; Zolpidem