Evaluation of Factors Associated With Appropriate Drug Prescription and Effectiveness of Informative and Educational Interventions—The EDU.RE.DRUG Project

Abstract

Background EDU.RE.DRUG study is a prospective, multicentre, open‐label, parallel‐arm, controlled, pragmatic trial directed to General Practitioners (GPs) and their patients. Methods The study data were retrieved from health-related administrative databases of four Local Health Units (LHUs) of Lombardy and four LHUs in Campania. According to LHU, the GPs/patients were assigned to (A) intervention on both GPs (feedback reports about appropriate prescribing among their patients and on-line courses) and patients (flyers and posters on proper drug use); (B) intervention on GPs; (C) intervention on patients; and (D) no intervention (control arm). A set of appropriate prescribing indicators (potential drug-drug interactions [pDDIs], potential and unnecessary therapeutic duplicates [pTDs], inappropriate prescriptions in elderly [ERD-list]) were measured at baseline and after the intervention phase. The effectiveness of the intervention was evaluated estimating the absolute difference in percentages of selected indicators carrying out linear random intercept mixed effect models. Results A cohort of 3,586 GPs (2,567 in intervention groups and 1,019 in the control group) was evaluated. In Campania, the mean pre-intervention percentage of patients with at least one pDDI was always greater than 20%, and always lower than 15% in Lombardy. The pre-post difference was quite heterogeneous among LHUs, ranging from 1.9 to -1.4 percentage points. The mean pre-intervention percentage of patients with pTDs ranged from 0.59 to 2.1%, with slightly higher values characterizing Campania LHUs. The magnitude of the pre-post difference was very low, ranging from -0.11 to 0.20. In Campania the mean pre-intervention percentage of patients with at least one ERD criterium was considerably higher than in Lombardy (approximately 30% in Lombardy and 50% in Campania). The pre-post difference was again quite heterogeneous. Results from models accounting for GP geographical belonging suggested that none of the interventions resulted in a statistically significant effect, for all the three indicators considered. Conclusions The proposed strategy was shown to be not effective in influencing the voluntary changes in GP prescription performance. However, the use of a set of explicit indicators was proved to be useful in quantify the inappropriateness. Further efforts are needed to find more efficient strategies and to design more tailored interventions.