Polypharmacy in general practice.

INTRODUCTION: Polypharmacy increases the risk of side effects and interactions. We quantified the prevalence of major polypharmacy (MPP) in a Danish county with 236,000 inhabitants, invited general practitioners (GPs) to participate in a quality improvement project and discussed the medication of 10-20 MPP patients selected by the participating GPs. MATERIAL AND METHODS: This was a prospective registry study of all prescriptions of subsidized drugs in the third quarter of 2005 for all inhabitants living in Roskilde County, Denmark. An audit was performed of the prescriptions of 220 MPP patients selected by the GPs based on a list of each MPP patient's medications. RESULTS: MPP patients constituted 2.1% of the county's population. GPs demonstrated a strong interest in auditing prescriptions. A large share of the patients selected by the GPs was treated with drugs which were no longer indicated, or with drugs with a doubtful indication. CONCLUSIONS: MPP compromises the GP's ability to manage medication of individual patients. Systematic audit of the total medication of patients should be introduced.

[Influencing the prescriptions of general practitioners via guidelines and feedback--secondary publication]. / Påvirkning af praktiserende laegers ordinationer via kliniske retningslinjer og feedback--sekundaerpublikation.

We investigated the effects of a multi-dimensional intervention on practice prescription patterns in five drug groups. The number of prescribed defined daily doses (DDDs) increased after the intervention, while potential savings/DDD decreased. The county's average cost/DDD fell to a level below the national average. It is possible to change general practitioners' prescription patterns without interfering with their clinical freedom or patients' access to treatment.

Changing GPs' prescription patterns through guidelines and feedback. Intervention study.

PURPOSE: To investigate whether and how a multi-dimensional intervention including clinical guidelines on the choice of medical treatment in the primary and the secondary health care sector, and individual feedback to general practices about their own and other practices' prescription patterns in five Anatomical Therapeutic Chemical classification system (ATC)-groups was followed by changes in the practices' prescription pattern. METHODS: Prospective historical registry study and a questionnaire study of GPs' self-reported use of guidelines and feedback. RESULTS: In every ATC-group the number of prescribed defined daily doses (DDDs) kept growing after the intervention, while potential savings by DDD decreased. Individual practices' changes in the prescription pattern differed by ATC-group and practices with high potential savings/DDD before the intervention showed the greatest relative reduction in potential savings/DDD. The county's average cost/DDD for the five ATC-groups declined from above the Danish average before the intervention to a level below the average cost/DDD after the intervention. In the questionnaire study (response rate: 79%), 69% of respondents had read the guidelines and 78% reported that the feedback influenced their prescription of drugs. CONCLUSIONS: The observed changes in drug costs and potential savings were not due to volume effects but a combination of price effects, including generic substitution and choice of less expensive analogues, demonstrating that it is possible to change GPs' prescription patterns without interfering with patients' access to treatment or with GPs' clinical freedom.'