Guidelines and educational outreach visits from community pharmacists to improve prescribing in general practice

Margaret Watson, David Gunnell, Tim Peters, Sara Brookes, Deborah Sharp

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objectives: To evaluate the effectiveness of guidelines with or without one-to-one educational outreach visits by community pharmacists in improving general practice prescribing for non-steroidal anti-inflammatory drugs (NSAIDs). Methods: Cluster randomised trial of 20 general practices within Avon, England. Practices were randomised to three groups: control; mailed guidelines; mailed guidelines plus educational outreach visits. General practitioners (GPs) in the latter group received two one-to-one outreach visits from community pharmacists. Changes in prescribing were measured using outcomes derived from prescribing analysis and cost (PACT) data. The primary outcome measure was change in the volume of prescribing for ibuprofen, diclofenac and naproxen as a percentage of total NSAID prescribing. Six secondary outcomes included other measures of prescribing quality and volume. A cost-benefit analysis was performed. Results: No significant differences were observed for the primary outcome measure: practices receiving outreach visits prescribed only 2.1% [95% confidence interval (CI): -0.8 to 5.0] more of the three recommended NSAIDs than the control practices did and 1.6% (95% CI: -1.4 to 4.7) more than practices that received guidelines only. Following adjustment for multiple comparisons, only one secondary outcome showed a statistically significant difference between the groups: the proportion of prescribing of the five most frequently used drugs was 2.2% (95% CI: 0.9 to 3.6) higher in the educational outreach group compared with the control group. A net increase in costs was shown with both interventions. Conclusions: Although good prescribing at baseline in the participating practices limited the capacity for improvement, this trial provides no evidence that guidelines with or without educational outreach visits from community pharmacists lead to substantial improvements in prescribing behaviour.
LanguageEnglish
Pages207-213
Number of pages7
JournalJournal of Health Services Research & Policy
Volume6
Issue number4
DOIs
Publication statusPublished - 1 Oct 2001

Fingerprint

Pharmacists
General Practice
Guidelines
Anti-Inflammatory Agents
Confidence Intervals
Outcome Assessment (Health Care)
Drug Prescriptions
Costs and Cost Analysis
Control Groups
Naproxen
Diclofenac
Ibuprofen
Drug and Narcotic Control
Practice Guidelines
England
Pharmaceutical Preparations
General Practitioners
Cost-Benefit Analysis

Keywords

  • one-to-one educational outreach visits
  • community pharmacists
  • non-steroidal anti-inflammatory drugs (NSAIDs)

Cite this

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title = "Guidelines and educational outreach visits from community pharmacists to improve prescribing in general practice",
abstract = "Objectives: To evaluate the effectiveness of guidelines with or without one-to-one educational outreach visits by community pharmacists in improving general practice prescribing for non-steroidal anti-inflammatory drugs (NSAIDs). Methods: Cluster randomised trial of 20 general practices within Avon, England. Practices were randomised to three groups: control; mailed guidelines; mailed guidelines plus educational outreach visits. General practitioners (GPs) in the latter group received two one-to-one outreach visits from community pharmacists. Changes in prescribing were measured using outcomes derived from prescribing analysis and cost (PACT) data. The primary outcome measure was change in the volume of prescribing for ibuprofen, diclofenac and naproxen as a percentage of total NSAID prescribing. Six secondary outcomes included other measures of prescribing quality and volume. A cost-benefit analysis was performed. Results: No significant differences were observed for the primary outcome measure: practices receiving outreach visits prescribed only 2.1{\%} [95{\%} confidence interval (CI): -0.8 to 5.0] more of the three recommended NSAIDs than the control practices did and 1.6{\%} (95{\%} CI: -1.4 to 4.7) more than practices that received guidelines only. Following adjustment for multiple comparisons, only one secondary outcome showed a statistically significant difference between the groups: the proportion of prescribing of the five most frequently used drugs was 2.2{\%} (95{\%} CI: 0.9 to 3.6) higher in the educational outreach group compared with the control group. A net increase in costs was shown with both interventions. Conclusions: Although good prescribing at baseline in the participating practices limited the capacity for improvement, this trial provides no evidence that guidelines with or without educational outreach visits from community pharmacists lead to substantial improvements in prescribing behaviour.",
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Guidelines and educational outreach visits from community pharmacists to improve prescribing in general practice. / Watson, Margaret; Gunnell, David; Peters, Tim; Brookes, Sara; Sharp, Deborah.

In: Journal of Health Services Research & Policy , Vol. 6, No. 4, 01.10.2001, p. 207-213.

Research output: Contribution to journalArticle

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