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Evaluation of patient outcomes in an area where prescribing of anticholinergic antidepressants was influenced by academic detailing

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Abstract

Objective:To evaluate, on a patient level, the effect of a "physician-level intervention" that successfully reduced the incidence of anticholinergic antidepressant prescribing. Design:Cross-sectional surveys with questionnaires sent before and after intervention. Setting:Additional study in an RCT to reduce the prescribing of highly anticholinergic antidepresssants in the elderly in the South Holland Islands.Participants:Elderly patients (age 60-95 years) who used antidepressants in 1995 and 1996 in our research area according to a health insurance prescription database. Main outcome measures:Prevalence of adverse events related to antidepressant use, severity of depression and quality of life were compared in users living in the intervention and control areas. Results:Prior to our intervention we sent 2,359 questionnaires of which we could use 827 (3528%) for analysis. At baseline, there were no statistically significant differences between the intervention and control areas. After the intervention 3,375 questionnaires were sent, of which 939 (28%) could be used. The occurrence of "dry mouth" and "coughing" and the "amount of pain" were lower in the intervention area compared to the control area (p < 0.05).Conclusion:We found no indications that adverse events, severity of depression or quality of life were changed in an unfavourable direction, when comparing patients inside and outside the intervention area.

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References

  1. Bero LA, Mays NB, Barjesteh K, Bond C. Expanding the roles of outpatient pharmacists: effects on health services utilisation, costs, and patient outcomes. Cochrane Database Syst Rev 2000;2.

  2. Rutten F. Economic evaluation and health care decision-making. Health Policy 1996;36(3):215-29.

    PubMed  Google Scholar 

  3. Braybrook S, Walker R. Influencing NSAID prescribing in primary care using different feedback strategies. Pharm World Sci 2000;22(2):39-46.

    PubMed  Google Scholar 

  4. Davis DA, Taylor-Vaisey A. Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. Cmaj 1997;157(4):408-16.

    PubMed  Google Scholar 

  5. Leufkens HG, Urquhart J. Variability in patterns of drug usage. J Pharm Pharmacol 1994;46 Suppl 1:433-7.

    PubMed  Google Scholar 

  6. Avorn J, Soumerai SB, Everitt DE, Ross-Degnan D, Beers MH, Sherman D, et al. A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. N Engl J Med 1992;327:168-73.

    PubMed  Google Scholar 

  7. van Eijk MEC, Avorn J, Porsius AJ, de Boer A. Reducing prescribing of highly anticholinergic antidepressants for elderly people: randomised trial of group versus individual academic detailing. BMJ 2001;322(7287):654.

    PubMed  Google Scholar 

  8. Menting JEA, Honig A, Verhey FRJ, Hartmans M, Rozendaal N, Vet HCWd, et al. SSRIs in the treatment of eldery depressed patients: a qualitative analyses of the literature on their efficacy and side-effects. Int Clin Psychopharmacol 1996;11:165-75.

    PubMed  Google Scholar 

  9. Sclar DA, Robison LM, Skaer TL, Legg RF, Nemec NL, Galin RS, et al. Antidepressant pharmacotherapy: economic outcomes in a health maintenance organization. Clin Ther 1994;16(4):715-30;.

    PubMed  Google Scholar 

  10. Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 1997;157(14):1531-6.

    PubMed  Google Scholar 

  11. van Marwijk H, Grundmeijer H, Brueren M, Sigling H, Stolk J, van Gelderen M, et al. [Dutch primary care guidelines for the treatment of depression] NHG-standaard depressie. Huisarts Wet 1994;37(11):482-90.

    Google Scholar 

  12. Groot. Consensus depressie bij volwassenen. NTvG 1995;139(24):1237-9.

    Google Scholar 

  13. Avorn J. Including elderly people in clinical trials [editorial; comment]. BMJ 1997;315(7115):1033-4.

    PubMed  Google Scholar 

  14. van Eijk MEC, Avorn J, Porsius AJ, De Boer A. Reducing anticholinergic antidepressant use in the elderly: a randomized trial of group vs individual 'academic detailing'. Br J Clin Pharmacol 2000;49:383P-384P.

    Google Scholar 

  15. Bentsen BG, Natvig B, Winnem M. Questions you didn't ask? COOP/WONCA Charts in clinical work and research. World Organization of Colleges, Academies and Academic Associations of General Practitioners/Family Physicists. Fam Pract 1999;16(2):190-5.

    PubMed  Google Scholar 

  16. Nelson E, Wasson J, Kirk J, Keller A, Clark D, Dietrich A, et al. Assessment of function in routine clinical practice: description of the COOP Chart method and preliminary findings. J Chronic Dis 1987;40(Suppl 1):55S-69S.

    PubMed  Google Scholar 

  17. Doetch TM, Alger BH, Glasser M, Levenstein J. Detecting depression in elderly outpatients: findings from depression symptom scales and the Dartmouth COOP charts. Fam Med 1994;26(8):519-23.

    PubMed  Google Scholar 

  18. Van Weel C. Functional status in primary care: COOP/WONCA charts. Disabil Rehabil 1993;15(2):96-101.

    PubMed  Google Scholar 

  19. Andres E, Temme M, Raderschatt B, Szecsenyi J, Sandholzer H, Kochen MM. COOP-WONCA charts: a suitable functional status screening instrument in acute low back pain? Br J Gen Pract 1995;45(401):661-4.

    PubMed  Google Scholar 

  20. Strom B, editor. Pharmacoepidemiology, 2 ed. Philadelphia: John Wiley & Sons, 1994.

    Google Scholar 

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Authors and Affiliations

  1. Dutch Institute for the Effective Use of Medication "DGV", 3502 GB, Utrecht, The Netherlands

    M.E.C. van Eijk

  2. Anthonius de Boer: Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute of Pharmaceutical Sciences, Utrecht, The Netherlands

    S.V. Belitser, A.J Porsius & A. de Boer

Authors
  1. M.E.C. van Eijk
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  2. S.V. Belitser
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  3. A.J Porsius
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  4. A. de Boer
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Correspondence to M.E.C. van Eijk.

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van Eijk, M., Belitser, S., Porsius, A. et al. Evaluation of patient outcomes in an area where prescribing of anticholinergic antidepressants was influenced by academic detailing. Pharm World Sci 24, 144–148 (2002). https://doi.org/10.1023/A:1019559301580

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