Guidelines and educational outreach visits from community pharmacists to improve prescribing in general practice: a randomised controlled trial

摘要

Objectives: To evaluate the effectiveness of guidelines with or without one-to-one educational outreach visits byncommunity pharmacists in improving general practice prescribing for non-steroidal anti-in ammatory drugsn(NSAIDs).nMethods: Cluster randomised trial of 20 general practices within Avon, England. Practices were randomised tonthree groups: control; mailed guidelines; mailed guidelines plus educational outreach visits. General practitionersn(GPs) in the latter group received two one-to-one outreach visits from community pharmacists. Changes innprescribing were measured using outcomes derived from prescribing analysis and cost (PACT) data. The primarynoutcome measure was change in the volume of prescribing for ibuprofen, diclofenac and naproxen as a percentagenof total NSAID prescribing. Six secondary outcomes included other measures of prescribing quality and volume. Ancost–bene. t analysis was performed.nResults: No signi. cant differences were observed for the primary outcome measure: practices receiving outreachnvisits prescribed only 2.1% [95% con. dence interval (CI): ¡0.8 to 5.0] more of the three recommended NSAIDsnthan the control practices did and 1.6% (95% CI: ¡1.4 to 4.7) more than practices that received guidelines only.nFollowing adjustment for multiple comparisons, only one secondary outcome showed a statistically signi. cantndifference between the groups: the proportion of prescribing of the . ve most frequently used drugs was 2.2% (95%nCI: 0.9 to 3.6) higher in the educational outreach group compared with the control group. A net increase in costs wasnshown with both interventions.nConclusions: Although good prescribing at baseline in the participating practices limited the capacity fornimprovement, this trial provides no evidence that guidelines with or without educational outreach visits fromncommunity pharmacists lead to substantial improvements in prescribing behaviour.