Strategies for Improving Proton Pump Inhibitors (PPIs) Prescription Associated to Non-steroidal Anti-inflammatory Drugs (NSAIDs)
- Conditions
- Adverse Events
- Interventions
- Behavioral: Group education, audit-feedback and computer supportBehavioral: Audit-feedback and computer supportBehavioral: Control
- Registration Number
- NCT01128127
- Lead Sponsor
- Servicio Canario de Salud
- Brief Summary
Background
Despite the low prevalence of serious complications associated with non-steroidal anti-inflammatory drugs (NSAIDs) use, there is a widespread use of gastroprotective proton pump inhibitors (PPIs) in order to prevent adverse effects. Inappropriate prescribing of PPIs includes overprescribing for inappropriate indications and the misuse of first choice in their class in terms of efficacy, safety and cost. A series of recommendations, based on the best available scientific evidence, has been established to justify prophylaxis with PPIs associated to NSAIDs. Therefore, there is the need to encourage the incorporation of this knowledge to guide decisions of physicians with the objective of improving patient health and sustainability of the Public Health Service. Although since long ago there is a great concern regarding rational use of drugs, the available evidence for the most appropriate strategies to improve prescribing is scarce. Passive dissemination of research findings are generally ineffective and at best result in small changes in practice. Multifaceted intervention targeting different barriers to change are more likely to be effective than single intervention.
Objectives
The objective of this study is to evaluate the effectiveness of two educational multifaceted strategies aimed at improving PPIs prescription associated to NSAIDs use in primary care. We will also compare the cost-effectiveness of such strategies.
Hypothesis
It is hypothesized that a quality improvement intervention directed to primary care physicians will decrease inappropriate PPIs prescriptions associated to NSAIDs prescription.
Methodology
A three-arm prospective quasi-randomized controlled trial will test the effectiveness of two strategies for improving PPI prescription associated to NSAID in primary care context. Three of the Canary Islands will be selected and randomized to either a experimental multifaceted intervention (group education+audit-feedback+CCDSS) group, a experimental multifaceted intervention (audit-feedback+CCDSS) group, or a control group (usual intervention). From each of these islands, 6-8 primary care centers will be randomly selected to received the intervention practices. All family physicians working at each randomly selected primary care center were mandatorily included. Primary outcome measure is reduction of inappropriate PPI prescription. The efficacy of the intervention will be examined within a 3, 6 and a 12 month follow up.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- WITHDRAWN
- Sex
- All
- Target Recruitment
- Not specified
- Primary care physicians
- Participating as a subject in any other clinical research study
- Have received any other intervention on the subject within the last 6 months
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Multifaceted intervention 1 Group education, audit-feedback and computer support psycho-educational workshop + audit-feedback + computer-based clinical decision support system (CCDSS) + usual intervention Multifaceted intervention 2 Audit-feedback and computer support audit-feedback + computer-based clinical decision support system (CCDSS) + usual intervention Control Control usual intervention
- Primary Outcome Measures
Name Time Method Rate of inappropriate PPI prescriptions one year Change in the proportion of inappropriate PPI prescription associated with NSAID prescription
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (1)
Servicio de Evaluación. Servicio Canario de Salud
🇪🇸Santa Cruz de Tenerife, Spain