Outcomes of an educational‐outreach service for community medical practitioners: non‐steroidal anti‐inflammatory drugs

Abstract

Objective Exploration of longer‐term outcomes of an ongoing educational‐outreach service for community doctors. Design Quasi‐experimental, with parallel and historical comparisons. Setting Since 1992, a teaching‐hospital‐based service has been providing advice and information on drugs and therapeutic strategies to community medical practitioners. Participants 210 doctors practising in a particular area of metropolitan Adelaide (79% general practitioners; 21% specialists). Interventions Two surgery visits during 1992 focused on better use of prescribed non‐steroidal anti‐inflammatory drugs (NSAIDs). Subsequent visits on other topical therapeutic issues have occurred regularly. Main outcome measures Doctor participation in the service; supply of prescription NSAIDs; hospital admissions for gastrointestinal (Gl) effects of NSAID use. Results 89% of doctors practising within the service area received the first visit on NSAIDs and 86% received the second visit. More than 85% continue to receive the service. Relative to a comparison area, aggregate reductions of 9% and 28%, respectively, were observed in two different measures of NSAID use. During an 11‐year observation period, a single change point in the number of hospital admissions for Gl disorders occurred in the service area, coinciding with delivery of the NSAID program. In the five years since the visits commenced, a 70% reduction in admissions was observed. No notable changes in hospital admission rates occurred in the comparison area. Conclusions A continuing education and support service for community medical practitioners which uses principally academic detailing methods in its contact with doctors has contributed to sustained changes in prescribed NSAID use over a five‐ year period. A focus on risk‐minimisation in prescribing of NSAIDs appears to have contributed to reductions in hospitalisations for Gl adverse events.

Protocol for the PINCER trial: a cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

“…- Those being prescribed warfarin who had not had an INR test within the previous 12 weeks (this is the maximum interval recommended by the British National Formulary[23]).…”

Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study

“…We know that patients with two or more risk factors for gastrointestinal bleeds are at high risk, 22 and that various interventions can reduce the risks of these drugs. [23][24][25] For example, co-prescription with ulcer healing drugs can reduce the risk of gastrointestinal bleeds 24 and educational interventions have been shown to improve the safety of GP prescribing. 23 25 Indeed, in a large Australian study an educational intervention focusing on NSAIDs reduced by 70% the rate of hospital admissions for upper gastrointestinal ulceration, bleeding and perforation.…”

“…23 25 Indeed, in a large Australian study an educational intervention focusing on NSAIDs reduced by 70% the rate of hospital admissions for upper gastrointestinal ulceration, bleeding and perforation. 25 In terms of monitoring, some of the best evidence for improvements in primary care relate to the monitoring of warfarin. [26][27][28][29][30] The results of these studies may not be applicable to other drugs, but they suggest that nurse led monitoring clinics, 28 computerised decision support systems, 27 28 patient education and involvement, 26 and patient selfmanagement 29 30 may help to improve control through improved monitoring.…”

Guidelines and educational outreach visits from community pharmacists to improve prescribing in general practice: a randomised controlled trial

“…One randomised trial has been conducted of one-to-one educational outreach visits from pharmacists in the UK, 10 but the visitor was not a community pharmacist and the visits were not part of a guideline implementation strategy. A recent study in Australia reported reduced hospital admissions for perforations, ulcers and gastrointestinal bleeding in areas where primary care physicians had received educational outreach visits from clinical pharmacists regarding the appropriate use of non-steroidal anti-in ammatory drugs (NSAIDs), 11 highlighting a potential clinical bene t from interventions such as the one evaluated here. This paper presents the results of a randomised controlled trial designed to evaluate the effect of guidelines with or without educational outreach visits from community pharmacists to improve the prescribing of NSAIDs.…”