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A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis
BACKGROUND: Medication errors are common in primary care and are associated with considerable risk of patient harm. We tested whether a pharmacist-led, information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lancet Publishing Group
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3328846/ https://www.ncbi.nlm.nih.gov/pubmed/22357106 http://dx.doi.org/10.1016/S0140-6736(11)61817-5 |
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author | Avery, Anthony J Rodgers, Sarah Cantrill, Judith A Armstrong, Sarah Cresswell, Kathrin Eden, Martin Elliott, Rachel A Howard, Rachel Kendrick, Denise Morris, Caroline J Prescott, Robin J Swanwick, Glen Franklin, Matthew Putman, Koen Boyd, Matthew Sheikh, Aziz |
author_facet | Avery, Anthony J Rodgers, Sarah Cantrill, Judith A Armstrong, Sarah Cresswell, Kathrin Eden, Martin Elliott, Rachel A Howard, Rachel Kendrick, Denise Morris, Caroline J Prescott, Robin J Swanwick, Glen Franklin, Matthew Putman, Koen Boyd, Matthew Sheikh, Aziz |
author_sort | Avery, Anthony J |
collection | PubMed |
description | BACKGROUND: Medication errors are common in primary care and are associated with considerable risk of patient harm. We tested whether a pharmacist-led, information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to hazardous prescribing and inadequate blood-test monitoring of medicines 6 months after the intervention. METHODS: In this pragmatic, cluster randomised trial general practices in the UK were stratified by research site and list size, and randomly assigned by a web-based randomisation service in block sizes of two or four to one of two groups. The practices were allocated to either computer-generated simple feedback for at-risk patients (control) or a pharmacist-led information technology intervention (PINCER), composed of feedback, educational outreach, and dedicated support. The allocation was masked to general practices, patients, pharmacists, researchers, and statisticians. Primary outcomes were the proportions of patients at 6 months after the intervention who had had any of three clinically important errors: non-selective non-steroidal anti-inflammatory drugs (NSAIDs) prescribed to those with a history of peptic ulcer without co-prescription of a proton-pump inhibitor; β blockers prescribed to those with a history of asthma; long-term prescription of angiotensin converting enzyme (ACE) inhibitor or loop diuretics to those 75 years or older without assessment of urea and electrolytes in the preceding 15 months. The cost per error avoided was estimated by incremental cost-effectiveness analysis. This study is registered with Controlled-Trials.com, number ISRCTN21785299. FINDINGS: 72 general practices with a combined list size of 480 942 patients were randomised. At 6 months' follow-up, patients in the PINCER group were significantly less likely to have been prescribed a non-selective NSAID if they had a history of peptic ulcer without gastroprotection (OR 0·58, 95% CI 0·38–0·89); a β blocker if they had asthma (0·73, 0·58–0·91); or an ACE inhibitor or loop diuretic without appropriate monitoring (0·51, 0·34–0·78). PINCER has a 95% probability of being cost effective if the decision-maker's ceiling willingness to pay reaches £75 per error avoided at 6 months. INTERPRETATION: The PINCER intervention is an effective method for reducing a range of medication errors in general practices with computerised clinical records. FUNDING: Patient Safety Research Portfolio, Department of Health, England. |
format | Online Article Text |
id | pubmed-3328846 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | Lancet Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-33288462012-04-23 A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis Avery, Anthony J Rodgers, Sarah Cantrill, Judith A Armstrong, Sarah Cresswell, Kathrin Eden, Martin Elliott, Rachel A Howard, Rachel Kendrick, Denise Morris, Caroline J Prescott, Robin J Swanwick, Glen Franklin, Matthew Putman, Koen Boyd, Matthew Sheikh, Aziz Lancet Articles BACKGROUND: Medication errors are common in primary care and are associated with considerable risk of patient harm. We tested whether a pharmacist-led, information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to hazardous prescribing and inadequate blood-test monitoring of medicines 6 months after the intervention. METHODS: In this pragmatic, cluster randomised trial general practices in the UK were stratified by research site and list size, and randomly assigned by a web-based randomisation service in block sizes of two or four to one of two groups. The practices were allocated to either computer-generated simple feedback for at-risk patients (control) or a pharmacist-led information technology intervention (PINCER), composed of feedback, educational outreach, and dedicated support. The allocation was masked to general practices, patients, pharmacists, researchers, and statisticians. Primary outcomes were the proportions of patients at 6 months after the intervention who had had any of three clinically important errors: non-selective non-steroidal anti-inflammatory drugs (NSAIDs) prescribed to those with a history of peptic ulcer without co-prescription of a proton-pump inhibitor; β blockers prescribed to those with a history of asthma; long-term prescription of angiotensin converting enzyme (ACE) inhibitor or loop diuretics to those 75 years or older without assessment of urea and electrolytes in the preceding 15 months. The cost per error avoided was estimated by incremental cost-effectiveness analysis. This study is registered with Controlled-Trials.com, number ISRCTN21785299. FINDINGS: 72 general practices with a combined list size of 480 942 patients were randomised. At 6 months' follow-up, patients in the PINCER group were significantly less likely to have been prescribed a non-selective NSAID if they had a history of peptic ulcer without gastroprotection (OR 0·58, 95% CI 0·38–0·89); a β blocker if they had asthma (0·73, 0·58–0·91); or an ACE inhibitor or loop diuretic without appropriate monitoring (0·51, 0·34–0·78). PINCER has a 95% probability of being cost effective if the decision-maker's ceiling willingness to pay reaches £75 per error avoided at 6 months. INTERPRETATION: The PINCER intervention is an effective method for reducing a range of medication errors in general practices with computerised clinical records. FUNDING: Patient Safety Research Portfolio, Department of Health, England. Lancet Publishing Group 2012-04-07 /pmc/articles/PMC3328846/ /pubmed/22357106 http://dx.doi.org/10.1016/S0140-6736(11)61817-5 Text en © 2012 Elsevier Ltd. All rights reserved. This document may be redistributed and reused, subject to certain conditions (http://www.elsevier.com/wps/find/authorsview.authors/supplementalterms1.0) . |
spellingShingle | Articles Avery, Anthony J Rodgers, Sarah Cantrill, Judith A Armstrong, Sarah Cresswell, Kathrin Eden, Martin Elliott, Rachel A Howard, Rachel Kendrick, Denise Morris, Caroline J Prescott, Robin J Swanwick, Glen Franklin, Matthew Putman, Koen Boyd, Matthew Sheikh, Aziz A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis |
title | A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis |
title_full | A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis |
title_fullStr | A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis |
title_full_unstemmed | A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis |
title_short | A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis |
title_sort | pharmacist-led information technology intervention for medication errors (pincer): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3328846/ https://www.ncbi.nlm.nih.gov/pubmed/22357106 http://dx.doi.org/10.1016/S0140-6736(11)61817-5 |
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