Results from a new HRB-funded study, which aims to reduce potentially inappropriate prescribing in older people, reveal the potential for improved medication use, significant cost savings and reduced risk from side effects for patients on a common medication for gastric problems (proton pump inhibitors). The findings are published today (9 November) in Annals of Family Medicine, the highest impact journal in the primary health care field.

Commenting on the findings, Graham Love, Chief Executive at the Health Research Board said, "Primary Care is the first point of call for many people who are ill, so it is essential that treatment is given based on solid evidence for the best patient outcomes. This study demonstrates the value of conducting research in primary care to ensure people get the right care at the right time and the health system benefits from lower costs and less pressure in acute services over time."

According to Dr Barbara Clyne, a HRB-funded researcher at RCSI (Royal College of Surgeons in Ireland), and the lead author on the paper, “This is the first completed randomised controlled trial (RCT) to look at improving appropriate prescribing in older people in a primary care setting in Ireland. Our findings indicated that after a relatively short intervention, namely a half-hour visit from a pharmacist to a GP to go through indicators of prescribing quality in older people, followed by the GP using a special software package to conduct a review of medication, we were able to reduce the likelihood of inappropriate prescribing in nearly 50% of patients in our intervention group.

“The findings substantiate earlier work by colleagues which estimated that approximately €22 million was spent on potentially inappropriate proton pump inhibitors during 2007 alone. The results also suggest that this intervention could reduce the risks from side-effects associated with these specific drugs, such as hip fractures and community acquired pneumonia. And if the protocol were applied to other types of drugs, it could reduce the overall risk of adverse drug effects in older people."

Professor Tom Fahey, the Principal Investigator at the HRB Centre for Primary Care Research (CPCR), RCSI, where the research was carried out, added, “The results of this study show that important health gains in terms of safety and costs of drugs can be made for the benefit of patients using information communication technology (ICT) and evidence-based information that supports GPs to conduct reviews of medication. The CPCR was recently awarded a second-phase of funding from the HRB worth €3 million, to continue its research into safer use of medicines, improved diagnosis, and more effective delivery of primary care. We will also collaborate with the newly established HRB Primary Care Trials Network Ireland in order to develop and test interventions that can enhance the health care received by individual patients as well as improve how we deliver, organise, and structure our health care services.”

The OPTI-SCRIPT research has been presented internationally, and lead author Dr Barbara Clyne, was selected as the winner of the North American Primary Care Research Group (NAPCRG)/ Society for Academic Primary Care (SAPC) Travel Award 2014. As the winner, Dr Clyne was invited to present this work at the 2015 SAPC meeting which was held in Oxford in July. The 2016 SAPC meeting will be hosted by RCSI through the Department of General Practice and the HRB CPCR.

Details of current and past work and projects of the Centre for Primary Care Research can be viewed online at www.hrbcentreprimarycare.ie.