Description and process evaluation of pharmacists’ interventions in a pharmacist-led information technology-enabled multicentre cluster randomised controlled trial for reducing medication errors in general practice (PINCER trial)

Howard, Rachel; Rodgers, Sarah; Avery, Anthony J; Sheikh, Aziz

doi:10.1111/ijpp.12039

Cited by 8 publications

(8 citation statements)

References 17 publications

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“…Forty-three studies were noninterventional (Table 1), and 13 included an intervention (Table 2). [59][60][61][62][63][64][65][66][67][68][69][70][71] The noninterventional studies that measured potentially inappropriate prescribing/ medications (PIPs) were all judged to be of low risk of bias because they included defined patient populations with clear process measure outcomes (whether or not a Beers list medication was on a patient's medication list, eg). The risk of bias assessment of noninterventional studies that measured ADEs or drug-related problems (DRPs) is shown in Supplementary Table 3.…”

Section: Resultsmentioning

confidence: 99%

Ambulatory Medication Safety in Primary Care: A Systematic Review

et al. 2022

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Purpose: To review the literature on medication safety in primary care in the electronic health record era.Methods: Included studies measured rates and outcomes of medication safety in patients whose prescriptions were written in primary care clinics with electronic prescribing. Four investigators independently reviewed titles and analyzed abstracts with dual-reviewer review for eligibility, characteristics, and risk of bias.Results: Of 1464 articles identified, 56 met the inclusion criteria. Forty-three studies were noninterventional and 13 included an intervention. The majority of the studies (30) used their own definition of error. The most common outcomes were potentially inappropriate prescribing/medications (PIPs), adverse drug events (ADEs), and potential prescribing omissions (PPOs). Most of the studies only included high-risk subpopulations (39), usually older adults taking > 4 medications. The rate of PIPs varied widely (0.19% to 98.2%). The rate of ADEs was lower (0.47% to 14.7%). There was poor correlation of PIP and PPO with documented ADEs leading to physical harm.Conclusions: This literature is limited by its inconsistent and highly variable outcomes. The majority of medication safety studies in primary care were in high-risk populations and measured potential harms rather than actual harms. Applying algorithms to primary care medication lists significantly overestimates rate of actual harms.

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Section: Resultsmentioning

confidence: 99%

Ambulatory Medication Safety in Primary Care: A Systematic Review

et al. 2022

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“…The PINCER trial demonstrated the clinical and cost‐effectiveness of pharmacist‐delivered medication reviews in primary care in the United Kingdom, 40 and their process evaluation showed that GPs acted on pharmacist recommendations the majority of times (61%), 41 compared with SPPiRE GPs who acted on self‐identified PIP 55% of the time. It may be that collaboration with a colleague facilitates making medication changes and a medicines management multimorbidity intervention that adopts this approach, 42 has recently been piloted in Irish primary care 43 .…”

Section: Discussionmentioning

confidence: 99%

Patient and general practitioner experiences of implementing a medication review intervention in older people with multimorbidity: Process evaluation of the SPPiRE trial

McCarthy¹,

Pericin

Smith

et al. 2022

Health Expectations

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Introduction The SPPiRE cluster randomized controlled trial found that a general practitioner (GP)‐delivered medication review that incorporated screening for potentially inappropriate prescriptions (PIP), a brown bag review and a patient priority assessment, resulted in a significant but small reduction in the number of medicines and no significant reduction in PIP. This process evaluation aims to explore the experiences of GPs and patients and the potential for system‐wide implementation. Methods The trial included 51 general practices and 404 participants with multimorbidity aged ≥65 years, prescribed ≥15 medicines. The process evaluation used mixed methods and ran parallel to the trial. Quantitative data was collected from the SPPiRE intervention website and analysed descriptively. Qualitative data on medication changes were collected from intervention GPs (18/26) and a purposive sample of intervention patients (27/208) via semi‐structured telephone interviews. All interviews were transcribed verbatim and analysed using a thematic analysis. Qualitative and quantitative data were integrated using a triangulation protocol. Results The analysis generated two themes, intervention implementation and mechanisms of action, and both were underpinned by the theme of context. Intervention delivery varied among practices and 45 patients (28%) had no review, primarily due to insufficient GP time. 80% of reviewed patients had ≥1 PIP identified, 59% had ≥1 problem identified during the brown bag review and 79% had ≥1 priority recorded. The brown bag review resulted in the most deprescription of medications. GPs and patients responded positively to the intervention but most GPs did not engage with the patient priority‐setting process. GPs identified a lack of integration into practice software and resources as barriers to future implementation. Conclusion The SPPiRE intervention had a small effect in reducing the number of medicines and this was primarily mediated through the brown bag review. The context of resource shortages and deep‐seated views around medical decision‐making influenced intervention implementation. Patient or Public Contribution Qualitative data on the implementation of the medication review and their wider views on their medicines was collected from older people with multimorbidity through semi‐structured telephone interviews. Clinical Trial Registration The SPPiRE trial was registered prospectively on the ISRCTN registry (ISRCTN12752680).

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“…This study is one of a growing number of process evaluations published independently of the main RCT findings [ 15 , 47 , 48 ] and is one of first to adopt a process evaluation framework explicitly intended for use in cluster RCTs [ 19 ]. Quantitative and qualitative data were systematically collected and rigorously analysed, providing an insight into patient and GP perspectives of the intervention and its implementation.…”

Section: Discussionmentioning

confidence: 99%

A process evaluation of a cluster randomised trial to reduce potentially inappropriate prescribing in older people in primary care (OPTI-SCRIPT study)

Clyne

Cooper

Hughes

et al. 2016

Trials

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BackgroundThe OPTI-SCRIPT cluster randomised controlled trial (RCT) found that a three-phase multifaceted intervention including academic detailing with a pharmacist, GP-led medicines reviews, supported by web-based pharmaceutical treatment algorithms, and tailored patient information leaflets, was effective in reducing potentially inappropriate prescribing (PIP) in Irish primary care. We report a process evaluation exploring the implementation of the intervention, the experiences of those participating in the study and lessons for future implementation.MethodsThe OPTI-SCRIPT trial included 21 GP practices and 196 patients. The process evaluation used mixed methods. Quantitative data were collected from all GP practices and semi-structured interviews were conducted with GPs from intervention and control groups, and a purposive sample of patients from the intervention group. All interviews were transcribed verbatim and analysed using a thematic analysis.ResultsDespite receiving a standardised academic detailing session, intervention delivery varied among GP practices. Just over 70 % of practices completed medicines review as recommended with the patient present. Only single-handed practices conducted reviews without patients present, highlighting the influence of practice characteristics and resources on variation. Medications were more likely to be completely stopped or switched to another more appropriate medication when reviews were conducted with patients present. The patient information leaflets were not used by any of the intervention practices. Both GP (32 %) and patient (40 %) recruitment rates were modest. For those who did participate, overall, the experience was positively viewed, with GPs and patients referring to the value of medication reviews to improve prescribing and reduce unnecessary medications. Lack of time in busy GP practices and remuneration were identified as organisational barriers to future implementation.ConclusionsThe OPTI-SCRIPT intervention was positively viewed by both GPs and patients, both of whom valued the study’s objectives. Patient information leaflets were not a successful component of the intervention. Academic detailing and medication reviews are important components in changing PIP, and having patients present during the review process seems to be a more effective approach for decreasing PIP.Trial registrationCurrent controlled trials ISRCTN41694007. Registered on 21 March 2012.

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Description and process evaluation of pharmacists’ interventions in a pharmacist-led information technology-enabled multicentre cluster randomised controlled trial for reducing medication errors in general practice (PINCER trial)

Cited by 8 publications

References 17 publications

Ambulatory Medication Safety in Primary Care: A Systematic Review

Ambulatory Medication Safety in Primary Care: A Systematic Review

Patient and general practitioner experiences of implementing a medication review intervention in older people with multimorbidity: Process evaluation of the SPPiRE trial

A process evaluation of a cluster randomised trial to reduce potentially inappropriate prescribing in older people in primary care (OPTI-SCRIPT study)

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