Table 3 Impact of interventions to reduce use
From: Bridging evidence-practice gaps: improving use of medicines in elderly Australian veterans
Intervention number and topic (number of veterans targeted) | Targeted therapy | Proportion of veterans on targeted therapy at baseline (%) | 24 month pre-intervention trend | Intervention effect (%) | 20 month post intervention trend | Estimated number with changed behaviour as a result of intervention; sustained over two years post intervention |
|---|---|---|---|---|---|---|
4: Clinical risk management: NSAIDs (n = 9885) | Reduce NSAID use in those with heart failure | 15.6% | Trend decreasing − 0.8% per month | −11.4% (p < 0.0001) | Trend still decreasing (non-significant to prior) − 0.7% per month (p = 0.87) | 1163 (680 heart failure patients and 483 diabetes patients) |
Reduce NSAID use in those with diabetes | 17.9% | Trend decreasing − 1.2% per month | −10.2% (p < 0.0001) | Trend still decreasing but reduced to − 0.3% per month p = 0.006 | ||
5: Antidepressants: three steps towards safer use (n = 42196) | Reduce antidepressant duplication | 3.5% | Trend increasing 0.2% per month | 0.6% p = 0.72 | Trend increasing at a rate of 0.5% per month p = 0.05 | No effect |
Reduce antidepressants with tramadol | 5.8% | Trend decreasing − 0.6% per month | −1.0% p = 0.64 | Trend still decreasing (non-significant to prior) − 0.8% per month p = 0.23 | ||
6: Inhaled respiratory medicines: optimising use (n = 28670) | Reduce multiple device use (3 different devices) | 9.5% | Trend increasing 0.2% per month | −0.11% p = 0.32 | Trend now decreasing (non-significant to prior) − 0.2% per month p = 0.23 | 100 patients no longer on 4 or more different devices |
Reduce multiple device use (4 or more different devices) | 2% | Trend increasing 0.1% per month | 2% p = 0.60 | Trend now decreasing − 0.6% per month p = 0.01 | ||
7: PPIs in GORD: Reduce the dose – keep the benefits (n = 62460) | Reduce use of high dose proton pump inhibitors (measured as increase in low-dose use) | 2.5% | Trend of low dose increasing 0.6% per month | 14.5% (p < 0.0001) Increase in low dose use | Trend of low dose increasing at greater rate 0.9% per month (p = 0.007) | 780 |
8: Reducing adverse drug events for your veteran patients (n = 32484) | Reduce use of potentially inappropriate medicines | 14.7% | Trend decreasing − 0.2% per month | −0.3% p = 0.12 | Trend still decreasing (non-significant to prior) − 0.2% per month p = 0.63 | No effect |
12: Antipsychotics in dementia (n = 6690) | Reduce antipsychotic use | 0.54% | Trend increasing 3.6% per month | −14.3% (p < 0.0001) | Trend increasing but at a reduced rate 0.8% per month (p < 0.0001) | 1725 |
14: COPD (n = 18096) | Reduce multiple device use (4 or more different devices) | 2% | Trend increasing 0.1% per month | 2% p = 0.68 | Trend now decreasing − 1.1% per month p <0.0001 | 105 patients no longer on 4 or more different devices |
Reduce use of nebules | 15.2% | Trend decreasing − 0.6% per month | 2% p = 0.07 | Trend decreasing (non-significant to prior) − 0.8% per month p = 0.2 |