How to Encourage Safer Drug Prescribing

The number and types of drugs and the potential for adverse events and interactions in multiple drug regimens has grown rapidly.  Physicians have a hard time keeping up and there is great variation in their use, and their appropriate use, of high-risk drugs.  Research published in the New England Journal of Medicine describes an intervention to modify such high-risk prescribing by primary care doctors.   (NEJM Article)   The study took place in Scotland across 33 primary care practices and attempted to improve use of non-steroidal anti-inflammatory agents and anti-platelet drugs, both of which are commonly prescribed and have frequent adverse effects.  The practices received education about the risks of prescribing these drugs, a financial incentive for reviewing prescribing of the drugs carefully and software which identified patients receiving the high-risk drugs and prompting review action by the physician.  The outcome measures were the occurrence of certain adverse events associated with the non-optimal prescribing of these medications.  The intervention went on for 48 weeks and data was collected for another 48 weeks after the intervention.  Over 33,000 patients had risk factors relating to use of these compounds.

During the intervention period the number of patients with risk factors who were prescribed a high-risk drug declined from over 3.5% to about 2% and stayed at that level during the post-intervention period, with reductions both in regard to ongoing prescriptions and new prescriptions.  There were also declines in 8 of 9 common adverse events resulting from high-risk prescribing.  Hospital admissions related to adverse events also declined substantially, by 90% for gastrointestinal bleeding and 67% for acute kidney injury.  The study suggests that well-designed interventions can focus physicians on improvement in areas presenting special risk to patients and can result in a reduction of patient harms.