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Effect of outreach visits on the prescribing of non-steroid anti-inflammatory drugs in general practice: A randomised controlled trial in southern Denmark
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. (Allmänmedicin)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. (Allmänmedicin)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. (Allmänmedicin)
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aims: To study the effects of outreach visits and a simple desk guide on the prescribing in general practice of non-steroid anti-inflammatory drugs (ATC code M01A), and its subgroups acetic acid derivatives (ATC code M01AB), oxicames (M01AC), propionic acid derivatives (M01AE), coxibes (M01AH), and other non-steroid anti-inflammatory drugs (M01AX), all expected to decrease.

Study population: 88 out of 94 general practices in the former Storstrøm County, accepting participation, were randomly allocated to an intervention or a control area.

Method: The year 1999 was used as a run-in-period, the year 2000 as an intervention period. All participating practices had an outreach visit during the run-in period, in the intervention area focussed on non-steroid anti-inflammatory drugs. Data on practice characteristics and on prescribing level for the six drug groups was obtained from the County Health Insurance database. Multiple linear regression analysis was used to evaluate differences in prescribing trends across the study period.

Results: After adjustments for differences in initial prescribing levels between the practices in the intervention and the control area no significant differences between the areas in prescribing volume of all non-steroid anti-inflammatory drugs. Neither were any significant differences seen for any of the non-steroid anti-inflammatory drug subgroups.

Conclusions: Contrary to expectations outreach visits and a simple desk guide did not seem to influence the prescribing of non-steroid anti-inflammatory drugs.

Keyword [en]
outreach visits, prescribing, NSAID, general practice, RCT
National Category
Basic Medicine
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:uu:diva-192314OAI: oai:DiVA.org:uu-192314DiVA: diva2:589376
Note

Manuscript

Available from: 2013-01-17 Created: 2013-01-17 Last updated: 2013-02-14
In thesis
1. Promoting Rational Drug Prescribing in General Practice
Open this publication in new window or tab >>Promoting Rational Drug Prescribing in General Practice
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims: To introduce the concepts “quality assurance”, “rational drug prescribing” and “outreach visits” in general practice in Storstrøm County, Denmark and study the effect of unsolicited mailed feedback and outreach visits on drug prescribing.

Methods: The first step was to generate standardised charts displaying the county variations of drug volume prescribing within 13 major drug groups at the second ATC-level. The charts were mailed unsolicited to the 94 general practices in the county. Each practice could identify its position within the county prescribing variation. This procedure was repeated every six months from 1992 to 1998. In 1998 annual outreach visit were offered to general practice and 88 of 94 practices accepted. The awareness of prescribing profiles was monitored during the visits in 1998 and 1999. In 2000 a randomised controlled trial allocating practices into two parallel arms was launched. Effects of two desk guides on rational drug prescribing promoted during outreach visits were evaluated.

Results: During the period of mailed feedback, there was a large variation in drug prescribing volumes between practices but little within-practice variation over time. No significant change was detected. Practitioners’ assessment of their own prescribing profiles improved significantly through the outreach visits. The prescribing of antibiotics was significantly affected by the desk guide whereas no effect was detected on the prescribing of non-steroid anti-inflammatory drugs.

Conclusions: Semi-annually mailed feedback over a seven-year period had no significant effect on prescribing volumes or variations in prescribing volumes, but some effect on the practitioners’ awareness of their own prescribing profiles. Outreach visits significantly improved the awareness. A randomised controlled trial using outreach visits combined with a simple desk guide affected the prescribing of some antibacterial drugs as intended whereas the similar intervention had no detectable effect on the prescribing of non-steroid anti-inflammatory drugs.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 64 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 858
Keyword
rational drug prescribing, family medicine, general practice, postal feedback, outreach visits, randomised controlled trial
National Category
Clinical Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-192315 (URN)978-91-554-8582-5 (ISBN)
Public defence
2013-03-01, Rudbeckssalen, Dag Hammarskjölds väg 20, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2013-02-07 Created: 2013-01-17 Last updated: 2013-02-14Bibliographically approved

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Vægter, KeldSvärdsudd, Kurt

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