GP-led, targeted interventions can significantly reduce the rate of high-risk prescribing and thus potentially protect patients from harm, a new study published in the New England Journal of Medicine has concluded.
High-risk prescribing and preventable drug-related complications in primary care are a key safety issue given that they are responsible for up to 4 percent of emergency hospital admissions. But researchers from NHS Tayside and the University of Dundee believe they may have found a relatively simple solution to help address this issue.
Their study looked at patient exposure to high-risk prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, or antiplatelet agents like aspirin - which can cause gastrointestinal, cardiovascular, and renal adverse drug events - using data from 33 general practices across Tayside, Scotland, with just over 200,000 registered patients.
Researchers staged a 48-week intervention consisting of professional education, informatics to facilitate reviews of patient treatment, and small financial incentives for practices to review patients, and found that they led to a significant 37 percent reduction in high-risk prescribing. Furthermore, this improvement was sustained in the 48 weeks after financial incentives to review were withdrawn.
The rate of hospital admissions for gastrointestinal ulcer or bleeding was significantly reduced from 55.7 to 37.0 admissions per 10,000 person-years, as was the rate of admissions for heart failure, the findings showed.
“This trial shows that GP-led, targeted review of patients with high-risk prescribing of two commonly prescribed classes of medicines can reduce such prescribing and appears to prevent unnecessary harm,” said Tobias Dreischulte, of NHS Tayside’s Medicines Governance Unit.
“This new study shows that relatively simple interventions can significantly reduce high-risk prescribing in a lasting way, and are associated with reductions in emergency hospital admission for related complications,” added Bruce Guthrie, of the University of Dundee.
“The NHS and many other health services internationally could, and we believe should, implement this kind of intervention now,” he stressed.