Safer Prescribing:A Trial of Education, Informatics, and Financial Incentives

BACKGROUND High-risk prescribing and preventable drug-related complications are common in primary care. We evaluated whether the rates of high-risk prescribing by primary care clinicians and the related clinical outcomes would be reduced by a complex intervention. METHODS In this cluster-randomized, stepped-wedge trial conducted in Tayside, Scotland, we randomly assigned participating primary care practices to various start dates for a 48-week intervention comprising professional education, informatics to facilitate review, and financial incentives for practices to review patients’ charts to assess appropriateness. The primary outcome was patient-level exposure to any of nine measures of high-risk prescribing of nonsteroidal antiinflammatory drugs (NSAIDs) or selected antiplatelet agents (e.g., NSAID prescription in a patient with chronic kidney disease or coprescription of an NSAID and an oral anticoagulant without gastroprotection). Prespecified secondary outcomes included the incidence of related hospital admissions. Analyses were performed according to the intention-to-treat principle, with the use of mixed-effect models to account for clustering in the data. RESULTS A total of 34 practices underwent randomization, 33 of which completed the study. Data were analyzed for 33,334 patients at risk at one or more points in the preintervention period and for 33,060 at risk at one or more points in the intervention period. Targeted high-risk prescribing was significantly reduced, from a rate of 3.7% (1102 of 29,537 patients at risk) immediately before the intervention to 2.2% (674 of 30,187) at the end of the intervention (adjusted odds ratio, 0.63; 95% confidence interval [CI], 0.57 to 0.68; P<0.001). The rate of hospital admissions for gastrointestinal ulcer or bleeding was significantly reduced from the preintervention period to the intervention period (from 55.7 to 37.0 admissions per 10,000 person-years; rate ratio, 0.66; 95% CI, 0.51 to 0.86; P = 0.002), as was the rate of admissions for heart failure (from 707.7 to 513.5 admissions per 10,000 person-years; rate ratio, 0.73; 95% CI, 0.56 to 0.95; P = 0.02), but admissions for acute kidney injury were not (101.9 and 86.0 admissions per 10,000 person-years, respectively; rate ratio, 0.84; 95% CI, 0.68 to 1.09; P = 0.19). CONCLUSIONS A complex intervention combining professional education, informatics, and financial incentives reduced the rate of high-risk prescribing of antiplatelet medications and NSAIDs and may have improved clinical outcomes

The effect of the SAFE or SORRY? programme on patient safety knowledge of nurses in hospitals and nursing homes: a cluster randomised trial

Background: patients in hospitals and nursing homes are at risk for the development of often preventable adverse events. Guidelines for the prevention of many types of adverse events are available, however compliance with these guidelines appears to be lacking. As a result many patients do not receive appropriate care. We developed a patient safety program that allows organisations to implement multiple guidelines simultaneously and therefore facilitates guideline use to improve patient safety. This program was developed for three frequently occurring nursing care related adverse events: pressure ulcers, urinary tract infections and falls. For the implementation of this program we developed educational activities for nurses as a main implementation strategy.Objectives: the aim of this study is to describe the effect of interactive and tailored education on the knowledge levels of nurses.Design: a cluster randomised trial was conducted between September 2006 and July 2008.Settings: ten hospital wards and ten nursing home wards participated in this study. Prior to baseline, randomisation of the wards to an intervention or control group was stratified for centre and type of ward.Participants: all nurses from participating wards.Methods: a knowledge test measured nurses’ knowledge on the prevention of pressure ulcers, urinary tract infections and falls, during baseline en follow-up. The results were analysed for hospitals and nursing homes separately.Results: after correction for baseline, the mean difference between the intervention and the control group on hospital nurses’ knowledge on the prevention of the three adverse events was 0.19 points on a zero to ten scale (95% CI: ?0.03 to 0.42), in favour of the intervention group. There was a statistically significant effect on knowledge of pressure ulcers, with an improved mean mark of 0.45 points (95% CI: 0.10–0.81). For the other two topics there was no statistically significant effect. Nursing home nurses’ knowledge did neither improve (0 points, CI: ?0.35 to 0.35) overall, nor for the separate subjects.Conclusion: the educational intervention improved hospital nurses’ knowledge on the prevention of pressure ulcers only. More research on long term improvement of knowledge is neede

Har liggetid i sykehus eller valg av omsorgsnivå for behandling betydning for behandlingskvalitet og ressursbruk for ulike pasientkategorier?

NORSK: Denne kartleggingen viser hva som finnes av en viss type forskning om eventuell effekt for behandlingskvalitet og ressursbruk av liggetid i sykehus og av behandling på ulike omsorgsnivå, på tvers av pasientkategorier. Utredningen ble bestilt av Senter for klinisk dokumentasjon i Helse Nord RHF vinteren 2009. Nasjonalt kunnskapssenter for helsetjenesten har gjort et systematisk og omfattende søk i databasene Cochrane Library, Medline og EMBASE for tre forskjellige problemstillinger innen temaet organisering av helsetjenester. Søkene resulterte totalt i 6170 treff. Av disse valgte vi totalt ut 247 referanser i henhold til de fastsatte inklusjonskriteriene, på grunnlag av tittel og sammendrag. Vi utformet én søkestrategi for hvert av de tre spørsmålene som ble stilt i bestillingen og de referansene som hvert søk resulterte i ble samlet under hvert spørsmål: 1. Hva er effekten av liggetider i sykehus for ressursbruk og medisinsk eller pasientopplevd behandlingskvalitet generelt eller ved ulike diagnoser? 2. Hva er effekten av ulike omsorgsnivåer (dagbehandling versus innleggelse) for ressursbruk og behandlingskvalitet generelt eller ved ulike diagnoser? 3. Hva er effekten av innleggelse ved sykehus sammenlignet med innleggelse på intermediært nivå for behandlingskvalitet, kostnader eller tilgjengelighet for pasientene for ulike diagnoser eller pasientkategorier? Sammendraget av hver enkelt studie er presentert. Vi har ikke vurdert den metodologiske kvaliteten av studiene og derfor har vi heller ikke kunnet ta stilling til om resultatene er troverdige. Vi minner om at det på våre hjemmesider ligger sjekklister for å vurdere kvaliteten av flere typer studiedesign: http://kunnskapssenteret.no/Verktøy/2031.cm

Effects of group interventions for children who experience family disruption.

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Interventions for ulceration and other skin changes caused by nerve damage in leprosy

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Developing theory-informed behaviour change interventions to implement evidence into practice : a systematic approach using the Theoretical Domains Framework

PMID: 22531013 [PubMed - indexed for MEDLINE] PMCID: PMC3443064 Free PMC ArticlePeer reviewedPublisher PD

Alternative opioidagonister i behandling av opioidavhengighet: oppdatering av en systematisk oversikt

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Preventive evidence into practice (PEP) study: implementation of guidelines to prevent primary vascular disease in general practice protocol for a cluster randomised controlled trial

There are significant gaps in the implementation and uptake of evidence-based guideline recommendations for cardiovascular disease (CVD) and diabetes in Australian general practice. This study protocol describes the methodology for a cluster randomised trial to evaluate the effectiveness of a model that aims to improve the implementation of these guidelines in Australian general practice developed by a collaboration between researchers, non-government organisations, and the profession.This study is funded by an Australian National Health and Medical Research Council (NHMRC) Partnership grant (ID 568978) together with the Australian National Heart Foundation, Royal Australian College of General Practitioners, and the BUPA Foundation. MH is supported by a NHMRC Senior Principle Research Fellowship