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Safer prescribing: a trial of education, informatics, and financial incentives.

Dreischulte, Tobias; Donnan, Peter; Grant, Aileen; Hapca, Adrian; McCowan, Colin; Guthrie, Bruce


Tobias Dreischulte

Peter Donnan

Aileen Grant

Adrian Hapca

Colin McCowan

Bruce Guthrie


Background: - High-risk prescribing and preventable drug-related complications are common in primary care. We evaluated whether the rates of high-risk prescribing by primary care clinicians and the related clinical outcomes would be reduced by a complex intervention. Methods: - In this cluster-randomized, stepped-wedge trial conducted in Tayside, Scotland, we randomly assigned participating primary care practices to various start dates for a 48-week intervention comprising professional education, informatics to facilitate review, and financial incentives for practices to review patients' charts to assess appropriateness. The primary outcome was patient-level exposure to any of nine measures of high-risk prescribing of nonsteroidal antiinflammatory drugs (NSAIDs) or selected antiplatelet agents (e.g., NSAID prescription in a patient with chronic kidney disease or coprescription of an NSAID and an oral anticoagulant without gastroprotection). Prespecified secondary outcomes included the incidence of related hospital admissions. Analyses were performed according to the intention-to-treat principle, with the use of mixed-effect models to account for clustering in the data. Results: - A total of 34 practices underwent randomization, 33 of which completed the study. Data were analyzed for 33,334 patients at risk at one or more points in the preintervention period and for 33,060 at risk at one or more points in the intervention period. Targeted high-risk prescribing was significantly reduced, from a rate of 3.7% (1102 of 29,537 patients at risk) immediately before the intervention to 2.2% (674 of 30,187) at the end of the intervention (adjusted odds ratio, 0.63; 95% confidence interval [CI], 0.57 to 0.68; P

Journal Article Type Article
Publication Date Mar 17, 2016
Journal New England journal of medicine
Print ISSN 0028-4793
Electronic ISSN 1533-4406
Publisher New Publisher Required
Peer Reviewed Peer Reviewed
Volume 374
Pages 1053-1064
Institution Citation DREISCHULTE, T., DONNAN, P., GRANT, A., HAPCA, A., MCCOWAN, C. and GUTHRIE, B. 2016. Safer prescribing: a trial of education, informatics, and financial incentives. New England journal of medicine [online], 374, pages 1053-1064. Available from:
Keywords High risk prescribing; Primary care; Tayside; Intervention


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