Reducing prescribing of highly anticholinergic antidepressants for elderly people: randomised trial of group versus individual academic detailing
Reducing prescribing of highly anticholinergic antidepressants for elderly people: randomised trial of group versus individual academic detailing
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DOI：
10.1136/bmj.322.7287.654
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发表时间：
2001-03-17
影响因子：
--
通讯作者：
de Boer, A
中科院分区：
文献类型：
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作者：
van Eijk, MEC;Avorn, J;de Boer, A
目的 使用学术细节比较个人教育访视与团体访视的效果，以讨论老年人服用高抗胆碱能抗抑郁药的处方。设计三组随机对照试验（个人访视、团体访视和对照组）。设置荷兰西南部，21 个同行评审小组组织了 190 名全科医生和 37 名药剂师，使用涵盖该地区国民健康保险覆盖人群的所有处方的数据库（约240 000）。干预，两个干预组的所有全科医生和药剂师都接受了两次教育访问。对于随机分配到个人就诊组的医生，70 名全科医生中有 43 名参与；在团体访视干预组中，七组中有五组（52 名全科医生中的 41 名）参与。 主要结果指标 接受高抗胆碱能抗抑郁药和低抗胆碱能抗抑郁药新处方的老年人（大于或等于 60 岁）数量。 结果 意向治疗分析发现，老年人开始使用高抗胆碱能抗抑郁药的比率降低了 26%（95% 置信区间 - 4%个人干预组中为 48%），团体干预组中为 45%（8% 至 67%）。个体干预组中较少使用抗胆碱能抗抑郁药的情况增加了 40%（6% 至 83%），而团体干预组则增加了 29%（-7% 至 79%）。 结论 个体和团体访视均减少了老年人中高抗胆碱能抗抑郁药的使用，并增加了较少抗胆碱能抗抑郁药的使用。这些方法是通过继续医学教育改进处方的实用方法。
Objective To compare the effect of individual educational visits versus group visits using academic detailing to discuss prescribing of highly anticholinergic antidepressants in elderly people.Design Randomised controlled trial with three arms (individual visits, group visits, and a control arm).Setting Southwest NetherlandsParticipants 190 general practitioners and 37 pharmacists organised in 21 peer review groups were studied using a database covering all prescriptions to people covered by national health insurance in the area (about 240 000). Intervention,All general practitioners and pharmacists in both intervention arms were offered two educational visits. For physicians in groups randomised to the individual visit arm, 43 of 70 general practitioners participated; in the group visit intervention arm, five of seven groups (41 of 52 general practitioners) participated.Main outcome measures Numbers of elderly people (greater than or equal to 60 years) with new prescriptions of highly anticholinergic antidepressants and less anticholinergic antidepressants.Results An intention to treat analysis found a 26% reduction in the rate of starting highly anticholinergic antidepressants in elderly people (95% confidence interval - 4% to 48%) in the individual intervention ann and 45% (8% to 67'%) in the group intervention arm. The use of less anticholinergic antidepressants increased by 40% (6% to 83%) in the individual intervention arm and 29% (-7% to 79%) in the group intervention arm.Conclusions Both the individual and the group visits decreased the use of highly anticholinergic antidepressants and increased the use of less anticholinergic antidepressant In elderly people. These approaches are practical means to improve prescribing by continuing medical education.