Addressing potentially inappropriate prescribing in older patients: development and pilot study of an intervention in primary care (the OPTI-SCRIPT study)
Open accessAbstract
BACKGROUND: Potentially inappropriate prescribing (PIP) in older people is common in primary care and can result in increased morbidity, adverse drug events, hospitalizations and mortality. The prevalence of PIP in Ireland is estimated at 36% with an associated expenditure of over €45 million in 2007. The aim of this paper is to describe the application of the Medical Research Council (MRC) framework to the development of an intervention to decrease PIP in Irish primary care. METHODS: The MRC framework for the design and evaluation of complex interventions guided the development of the study intervention. In the development stage, literature was reviewed and combined with information obtained from experts in the field using a consensus based methodology and patient cases to define the main components of the intervention. In the pilot stage, five GPs tested the proposed intervention. Qualitative interviews were conducted with the GPs to inform the development and implementation of the intervention for the main randomised controlled trial. RESULTS: The literature review identified PIP criteria for inclusion in the study and two initial intervention components - academic detailing and medicines review supported by therapeutic treatment algorithms. Through patient case studies and a focus group with a group of 8 GPs, these components were refined and a third component of the intervention identified - patient information leaflets. The intervention was tested in a pilot study. In total, eight medicine reviews were conducted across five GP practices. These reviews addressed ten instances of PIP, nine of which were addressed in the form of either a dose reduction or a discontinuation of a targeted medication. Qualitative interviews highlighted that GPs were receptive to the intervention but patient preference and time needed both to prepare for and conduct the medicines review, emerged as potential barriers. Findings from the pilot study allowed further refinement to produce the finalised intervention of academic detailing with a pharmacist, medicines review with web-based therapeutic treatment algorithms and tailored patient information leaflets. CONCLUSIONS: The MRC framework was used in the development of the OPTI-SCRIPT intervention to decrease the level of PIP in primary care in Ireland. Its application ensured that the intervention was developed using the best available evidence, was acceptable to GPs and feasible to deliver in the clinical setting. The effectiveness of this intervention is currently being tested in a pragmatic cluster randomised controlled trial. TRIAL REGISTRATION: Current controlled trials ISRCTN41694007.
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The interventions reported across the review varied widely and included a few targeting behavioural change at the individual patient level, such as weight reduction and smoking cessation programs, or at the level of healthcare professionals, such as interventions targeting general practitioners to reduce inappropriate prescribing behaviours.
“The interventions reported across the review varied widely and included a few targeting behavioural change at the individual patient level, such as weight reduction [27] and smoking cessation programs [10, 44, 49], or at the level of healthcare professionals, such as interventions targeting general practitioners to reduce inappropriate prescribing behaviours [26, 45, 46, 48].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [26]
17 of the 27 included studies used the MRC 2000 framework, the updated 2008 version, or a combination of the two.
“In particular, 17 of the 27 studies included in this review used the MRC 2000 framework, the updated 2008 version or a combination of the two [24–40].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [26]
Optimisation strategies applying qualitative methods tended to explore acceptability and feasibility issues.
“Optimisation strategies applying qualitative methods tended to explore acceptability and feasibility issues [26, 30, 32, 34, 39, 47, 48].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [26]
Six included studies evaluated more than one element; they explored the acceptability to different stakeholders together with either the intervention's effectiveness or cost-effectiveness.
“Six studies evaluated more than one element; in particular, they explored the acceptability to different stakeholders together with either the intervention’s effectiveness [25, 26, 28, 35, 38] or cost-effectiveness [33].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [26]
The majority of included studies (n = 16) subsequently refined the intervention to then test the optimised version within pilot studies or full-scale RCTs.
“The majority of studies (n = 16) subsequently refined the intervention to then test the optimised version of the intervention within pilot studies or full-scale RCTs [24–32, 34, 38–40, 43, 47, 48].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [26]
Several included studies employed well-established qualitative methods including interviews or focus groups with providers and recipients or relevant stakeholders, and observations and consensus processes including researchers, patients and clinical experts.
“Several studies employed well-established qualitative methods including interviews or focus groups with providers and recipients or relevant stakeholders [26, 30, 32, 34, 39, 47, 48] and observations and consensus processes including researchers, patients and clinical experts [31].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [26]
Eleven of the 15 included papers incorporated other approaches, tools, or resources as a component of the intervention design process.
“Eleven of the 15 papers incorporated other approaches, tools, or resources as a component of the intervention design process [14, 19–28].”
From Methods for designing interventions to change healthcare professionals’ behaviour: a systematic review (2017) · cites this paper as [24]
Two of the 15 included papers incorporated the Medical Research Council (MRC) framework.
“and two incorporated the Medical Research Council (MRC) framework [22, 24].”
From Methods for designing interventions to change healthcare professionals’ behaviour: a systematic review (2017) · cites this paper as [24]
Five of the 15 included papers incorporated just one other published tool.
“Five of 15 incorporated just one other published tool [20, 24, 26–28]”
From Methods for designing interventions to change healthcare professionals’ behaviour: a systematic review (2017) · cites this paper as [24]
Among the papers that covered barrier identification, the methods used included observations, interviews and/or focus groups, surveys, literature reviews, structured reflection by researchers, job analysis and expert consensus, and predictive studies to identify factors influencing behaviour.
“In the papers where barrier identification was covered, the methods included observations, interviews and/or focus groups [14, 18, 30–32], surveys [32], literature reviews [24], structured reflection by the researchers [32], job analysis and expert consensus [18], and undertaking a predictive study to identify factors influencing the behaviour [28].”
From Methods for designing interventions to change healthcare professionals’ behaviour: a systematic review (2017) · cites this paper as [24]
One of the 15 papers (Clyne et al. [24]) conducted a barriers assessment but did not describe how barriers were linked to intervention components.
“The second paper [24] did conduct a barriers assessment but did not describe how barriers were linked to intervention components.”
From Methods for designing interventions to change healthcare professionals’ behaviour: a systematic review (2017) · cites this paper as [24]
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- Authors
- Clyne, B., Bradley, M. C., Hughes, C. M., Clear, D., McDonnell, R., Williams, D., Fahey, T., & Smith, S. M.
- Affiliations
- Royal College of Surgeons in Ireland (IE)
- Queen's University Belfast (GB)
- Corresponding author
- Clyne, Barbara
- Venue
- BMC Health Services Research
- Published
- 2013-08-14
- Volume
- 13
- Issue
- 1
- Pages
- 307-307
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC3751793
- OpenAlex
- W2149239442
- Cited by
- 58
- References
- 47
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 4 · 2022: 2 · 2021: 3 · 2020: 8 · 2019: 6 · 2018: 3 · 2017: 7 · 2016: 9 · 2015: 8 · 2014: 2
- FWCI
- 2.95
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (Queen's University Belfast) (acceptedVersion, other-oa)
- Royal College of Surgeons in Ireland (submittedVersion)
- Figshare (submittedVersion, cc-by-nc-nd)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion)
- Funders
- Health Research Board (HRC/2007/1, PHD/2007/16)
- Royal College of Surgeons in Ireland
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- potentially inappropriate prescribing, elderly patients, primary care, academic detailing, patient information leaflets, pharmacist involvement, complex intervention development, MRC framework, dose reduction, drug discontinuation
- MeSH terms
- Aged, Algorithms, Humans, Ireland, Pilot Projects, Primary Health Care, Focus Groups, Consensus, Qualitative Research, Inappropriate Prescribing, General Practice
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