Effects of a primary care intervention to improve the quality of zolpidem prescriptions in elderly patients.

PURPOSE: The objective of this study was to measure the impact of an intervention on the prescription habits of general practitioners (GPs) in order to improve the quality of zolpidem prescriptions in patients aged 75 or older. METHODS: A prospective multicentric non-randomized trial was performed in the Metropolitan Granada Primary Healthcare Area (Andalusian Public Healthcare Service, Spain), which serves a total population of approximately 675,000 inhabitants. All health centers volunteering to participate in the trial were included. The intervention consisted of training sessions, individualized feedback, clinical information, and financial incentives. A daily dose over 5 mg was considered non-safe. Reduction in non-safe prescriptions of zolpidem in the elderly population became a quality prescribing indicator in a pay-for-performance scheme. RESULTS: Statistically significant differences versus baseline were found between the intervention and control groups in mean zolpidem prescription prevalence (28.5 vs. 37.5‰, respectively; p = 0.008) and mean non-safe zolpidem prescription prevalence (16.5 vs. 34.2‰, respectively; p < 0.001). At the end of the study period, the total number of non-safe prescriptions was 1309, 35% lower versus baseline, with a significant difference of p < 0.001; the number in the intervention (510 vs. 1118; p < 0.001) and control (799 vs. 893; p = 0.0064) groups was also significantly lower, with a significantly greater percentage reduction in the intervention group (54.4 vs. 10.5%, p < 0.001). CONCLUSION: The quality prescribing indicator in our area was improved by the intervention developed. Further studies that include an intervention group of GPs who receive no financial incentive are required to evaluate the relative importance of an economic reward in achieving this improvement.

Antidiabetic medications use trends in an Andalusian region from 2001 to 2014.

PURPOSE: There is a widening range of antidiabetic medications available; however changes in consumption patterns remain poorly documented. The aim of this study is to analyze the evolution of consumption of antidiabetic medications during the period 2001-2014 in an Andalusian region. METHODS: All antidiabetic medicines on the market were selected for analysis. Consumption data were obtained for the 15-year period and were expressed in defined daily doses (DDD) per 1000 inhabitants per day (DHD). RESULTS: During the study period consumption of insulins grew only a 2.2%, from 17.9 DHD to 18.3 DHD, while oral agents increased a 27.6%, from 41.3 DHD to 52.7 DHD. Consumption of sulfonylureas was gradually reduced from 30.1 DHD to 16.4 DHD but metformin (alone) usage increased from 4.3 DHD to 23.7 DHD, and was the most consumed agent in 2014. A rise in consumption of dipeptidyl peptidase-4 inhibitors and "other hypoglycemic agents" was also noticed. Overall expenditure in antidiabetic medications increased notably from 4.5 in 2001 to 14.4 million euros in 2014. CONCLUSION: We highlight the market uptake of antidiabetic drugs commercialized during the last decade; despite further exploration is needed to clarify the cost-benefit ratio of these new antidiabetic medicines.