Educational and Informative Interventions to Tackle Inappropriate Use of Drugs in Italy

NCT ID: NCT04030468

Last Updated: 2019-07-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

4840 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-04-20

Study Completion Date

2020-04-30

Brief Summary

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Pharmacological intervention is an essential step in health promotion. However, lots of drugs are often used in inappropriate ways, especially in elderly patients. This study is aiming at evaluating the effectiveness of educational and/or informative interventions addressed to general practitioners and their adult patients in Italy, in order to improve appropriateness of prescribing in primary care.

Detailed Description

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EDU.RE.DRUG project is a prospective, multicentre, open-label, parallel-arm, controlled, pragmatic trial directed to general practitioners (GPs) and their patients from two Italian regions (Campania and Lombardy), with the objective of investigating the practice of prescribing among GPs to highlight the most frequent events of inappropriateness and to implement ad hoc interventions for GPs and patients.

Appropriateness of prescribing in general practice will be assessed by evaluating selected prescribing, consumption and adherence indicators, using Regional administrative pharmaceutical prescription databases.

Primary care physicians and their patients will be assigned to four trial arms: informative intervention (leaflets and posters for patients), educational intervention (feedback reports and online CME courses for GPs), combined interventions, or no intervention. Intervention effectiveness will be assessed measuring the variation in rates of inappropriate prescription indicators after 1-year of follow-up.

EDU.RE.DRUG project will provide with improvements in the prescribing performance of GPs and in patients' adherence to treatment, with relevant clinical implications in terms of rational and safe use of drugs and optimized patient care, and with economic benefits (optimization of available resources use and savings in direct and indirect health costs).

Conditions

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Inappropriate Drug Prescription and Use

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

According to the Local Health Unit (LHU), general practitioners (GPs) with their patients will be assigned to one of the following intervention arms:

1. intervention on GPs (LHUs of Napoli 1 Nord and Bergamo)
2. intervention on patients (LHUs of Avellino and Val Padana-Mantova District)
3. intervention on GPs and patients (LHUs of Napoli 2 Centro and Brianza-Lecco District)
4. no intervention (LHUs of Caserta and Brianza-Monza Brianza District)
Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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General practitioners

Educational intervention

Group Type EXPERIMENTAL

Educational intervention addressed to general practitioners

Intervention Type OTHER

* feedback reports regarding the status of their patients according to the appropriateness indicators determined at baseline and the pooled prevalences for their patients, Local Health Units, and region
* Continuous Medical Education (CME) course

Patients

Informative intervention

Group Type EXPERIMENTAL

Informative intervention addressed to patients

Intervention Type OTHER

• leaflets and posters distributed in primary care ambulatories and community pharmacies, focusing on correct drug use

General practitioners and patients

Combined strategy

Group Type EXPERIMENTAL

Educational intervention addressed to general practitioners

Intervention Type OTHER

* feedback reports regarding the status of their patients according to the appropriateness indicators determined at baseline and the pooled prevalences for their patients, Local Health Units, and region
* Continuous Medical Education (CME) course

Informative intervention addressed to patients

Intervention Type OTHER

• leaflets and posters distributed in primary care ambulatories and community pharmacies, focusing on correct drug use

Control

No intervention

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Educational intervention addressed to general practitioners

* feedback reports regarding the status of their patients according to the appropriateness indicators determined at baseline and the pooled prevalences for their patients, Local Health Units, and region
* Continuous Medical Education (CME) course

Intervention Type OTHER

Informative intervention addressed to patients

• leaflets and posters distributed in primary care ambulatories and community pharmacies, focusing on correct drug use

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* general practitioners of the Italian National Health System (NHS) operating at December 31, 2016 belonging to the 8 Local Health Units involved in the project

Exclusion Criteria

* primary care pediatricians
Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Federico II University

OTHER

Sponsor Role collaborator

University of Milano Bicocca

OTHER

Sponsor Role collaborator

University of Milan

OTHER

Sponsor Role lead

Responsible Party

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Elena Tragni

Researcher at Epidemiology and Preventive Pharmacology Centre

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Alberico L Catapano

Role: PRINCIPAL_INVESTIGATOR

University of Milan

Locations

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SEFAP, University of Milan

Milan, MI, Italy

Site Status

Countries

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Italy

References

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Leendertse AJ, Egberts AC, Stoker LJ, van den Bemt PM; HARM Study Group. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med. 2008 Sep 22;168(17):1890-6. doi: 10.1001/archinternmed.2008.3.

Reference Type BACKGROUND
PMID: 18809816 (View on PubMed)

Buetow SA, Sibbald B, Cantrill JA, Halliwell S. Appropriateness in health care: application to prescribing. Soc Sci Med. 1997 Jul;45(2):261-71. doi: 10.1016/s0277-9536(96)00342-5.

Reference Type BACKGROUND
PMID: 9225413 (View on PubMed)

Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, Hanlon JT. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007 Jul 14;370(9582):173-184. doi: 10.1016/S0140-6736(07)61091-5.

Reference Type BACKGROUND
PMID: 17630041 (View on PubMed)

Goulding MR. Inappropriate medication prescribing for elderly ambulatory care patients. Arch Intern Med. 2004 Feb 9;164(3):305-12. doi: 10.1001/archinte.164.3.305.

Reference Type BACKGROUND
PMID: 14769626 (View on PubMed)

Fialova D, Topinkova E, Gambassi G, Finne-Soveri H, Jonsson PV, Carpenter I, Schroll M, Onder G, Sorbye LW, Wagner C, Reissigova J, Bernabei R; AdHOC Project Research Group. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005 Mar 16;293(11):1348-58. doi: 10.1001/jama.293.11.1348.

Reference Type BACKGROUND
PMID: 15769968 (View on PubMed)

Maio V, Yuen EJ, Novielli K, Smith KD, Louis DZ. Potentially inappropriate medication prescribing for elderly outpatients in Emilia Romagna, Italy: a population-based cohort study. Drugs Aging. 2006;23(11):915-24. doi: 10.2165/00002512-200623110-00006.

Reference Type BACKGROUND
PMID: 17109569 (View on PubMed)

Tragni E, Casula M, Pieri V, Favato G, Marcobelli A, Trotta MG, Catapano AL. Prevalence of the prescription of potentially interacting drugs. PLoS One. 2013 Oct 11;8(10):e78827. doi: 10.1371/journal.pone.0078827. eCollection 2013.

Reference Type BACKGROUND
PMID: 24147143 (View on PubMed)

Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med. 1991 Sep;151(9):1825-32.

Reference Type BACKGROUND
PMID: 1888249 (View on PubMed)

Casula M, Tragni E, Catapano AL. Adherence to lipid-lowering treatment: the patient perspective. Patient Prefer Adherence. 2012;6:805-14. doi: 10.2147/PPA.S29092. Epub 2012 Nov 8.

Reference Type BACKGROUND
PMID: 23152673 (View on PubMed)

Thomas AN, Boxall EM, Laha SK, Day AJ, Grundy D. An educational and audit tool to reduce prescribing error in intensive care. Qual Saf Health Care. 2008 Oct;17(5):360-3. doi: 10.1136/qshc.2007.023242.

Reference Type BACKGROUND
PMID: 18842975 (View on PubMed)

Ostini R, Hegney D, Jackson C, Williamson M, Mackson JM, Gurman K, Hall W, Tett SE. Systematic review of interventions to improve prescribing. Ann Pharmacother. 2009 Mar;43(3):502-13. doi: 10.1345/aph.1L488. Epub 2009 Mar 3.

Reference Type BACKGROUND
PMID: 19261953 (View on PubMed)

Maio V, Del Canale S, Abouzaid S; GAP Investigators. Using explicit criteria to evaluate the quality of prescribing in elderly Italian outpatients: a cohort study. J Clin Pharm Ther. 2010 Apr;35(2):219-29. doi: 10.1111/j.1365-2710.2009.01094.x.

Reference Type BACKGROUND
PMID: 20456742 (View on PubMed)

Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E; ISPOR Health Economic Evaluation Publication Guidelines-CHEERS Good Reporting Practices Task Force. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)--explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health. 2013 Mar-Apr;16(2):231-50. doi: 10.1016/j.jval.2013.02.002.

Reference Type BACKGROUND
PMID: 23538175 (View on PubMed)

Other Identifiers

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2017-002622-21

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

FARM12KSBT

Identifier Type: -

Identifier Source: org_study_id

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