Table 5 Overview of the OPTI-SCRIPT cluster RCT methods and findings [11]

Aim

To test the effectiveness of a multifaceted intervention in reducing the level of PIP in primary care.

Participants

Twenty-one general practices (intervention n = 11, control n = 10).

A total of 196 patients ≥70 years (intervention n = 99, control group n = 97) with ≥1 PIP drugs.

Outcome measure

Proportion of participant patients with PIP and the mean number of potentially inappropriate prescriptions per group.

Intervention group

The intervention consisted of:

 (1) Academic detailing with a pharmacist

  One session (lasting 30 minutes) where a pharmacist visited the practice to discuss PIP, medicines review and the web-based pharmaceutical treatment algorithms

 (2) Medicines review with web-based pharmaceutical treatment algorithms. GPs were asked to conduct one review per patient using the web-based platform to guide them through the process. The GP was presented with the specific PIP drug(s) for each patient, and for each PIP drug, there was a treatment algorithm with the following structure:

   a. The individual PIP with reason for concern

   b. Alternative pharmacological and non-pharmacological treatment options

   c. Background information (where relevant)

 3) Patient information leaflets to give to patients during the review. Each leaflet:

   a. Described the PIP and the reasons as to why it may be inappropriate

   b. Outlined the alternative pharmacological and non-pharmacological therapies GPs may offer

Control group

Control practices delivered usual care. Usual care for public General Medical Services (GMS) patients allows GPs to give a prescription on a monthly or 3 monthly basis.

Control practices received simple patient-level PIP feedback in the form of a list summarizing the medication class to which the individual patient’s potentially inappropriate medication belonged.

Control practices did not receive an academic detailing visit or were not prompted to carry out medicines review with the individual patients.

Results

Upon intervention completion:

 • OPTI-SCRIPT intervention group had significantly lower odds of having PIP than control group (adjusted OR 0.32, 95 % CI 0.15 to 0.70, P < 0.01).

 • Mean number of PIP drugs in the intervention group was 0.70, compared to 1.18 in the control group (P < 0.01).

 • The intervention was effective in reducing proton pump inhibitor prescribing (adjusted OR 0.30, 95 % CI 0.14 to 0.68, P = 0.04).