Bridging evidence-practice gaps: improving use of medicines in elderly Australian veterans
Background The Australian Government Department of Veterans’ Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and related health services, which implements interventions that include audit and feedback in the form of patient-specific feedback generated from a...
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| Published in | BMC health services research Vol. 13; no. 1; p. 514 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
London
BioMed Central
12.12.2013
BioMed Central Ltd |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1472-6963 1472-6963 |
| DOI | 10.1186/1472-6963-13-514 |
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| Abstract | Background
The Australian Government Department of Veterans’ Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and related health services, which implements interventions that include audit and feedback in the form of patient-specific feedback generated from administrative claims records. We aimed to determine changes in medicine use as a result of the program.
Methods
The program provides targeted patient-specific feedback to medical practitioners. The feedback is supported with educational material developed by a clinical panel, subject to peer review and overseen by a national editorial committee. Veterans who meet target criteria also receive educational brochures. The program is supported by a national call centre and ongoing national consultation. Segmented regression analyses (interrupted time series) were undertaken to assess changes in medication use in targeted veterans pre and post each intervention.
Results
12 interventions were included; three to increase medicine use, seven which aimed to reduce use, and two which had combination of messages to change use. All programs that aimed to increase medicine use were effective, with relative effect sizes at the time of the intervention ranging from 1% to 8%. Mixed results were seen with programs aiming to reduce inappropriate medicine use. Highly specific programs were effective, with relative effect sizes at the time of the intervention of 10% decline in use of NSAIDs in high risk groups and 14% decline in use of antipsychotics in dementia. Interventions targeting combinations of medicines, including medicine interactions and potentially inappropriate medicines in the elderly did not change practice significantly. Interventions with combinations of messages targeting multiple components of practice had an impact on one component, but not all components targeted.
Conclusions
The Veterans’ MATES program showed positive practice change over time, with interventions increasing use of appropriate medicines where under-use was evident and reduced use of inappropriate medicines when single medicines were targeted. Combinations of messages were less effective, suggesting specific messages focusing on single medicines are required to maximise effect. The program provides a model that could be replicated in other settings. |
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| AbstractList | The Australian Government Department of Veterans' Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and related health services, which implements interventions that include audit and feedback in the form of patient-specific feedback generated from administrative claims records. We aimed to determine changes in medicine use as a result of the program.BACKGROUNDThe Australian Government Department of Veterans' Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and related health services, which implements interventions that include audit and feedback in the form of patient-specific feedback generated from administrative claims records. We aimed to determine changes in medicine use as a result of the program.The program provides targeted patient-specific feedback to medical practitioners. The feedback is supported with educational material developed by a clinical panel, subject to peer review and overseen by a national editorial committee. Veterans who meet target criteria also receive educational brochures. The program is supported by a national call centre and ongoing national consultation. Segmented regression analyses (interrupted time series) were undertaken to assess changes in medication use in targeted veterans pre and post each intervention.METHODSThe program provides targeted patient-specific feedback to medical practitioners. The feedback is supported with educational material developed by a clinical panel, subject to peer review and overseen by a national editorial committee. Veterans who meet target criteria also receive educational brochures. The program is supported by a national call centre and ongoing national consultation. Segmented regression analyses (interrupted time series) were undertaken to assess changes in medication use in targeted veterans pre and post each intervention.12 interventions were included; three to increase medicine use, seven which aimed to reduce use, and two which had combination of messages to change use. All programs that aimed to increase medicine use were effective, with relative effect sizes at the time of the intervention ranging from 1% to 8%. Mixed results were seen with programs aiming to reduce inappropriate medicine use. Highly specific programs were effective, with relative effect sizes at the time of the intervention of 10% decline in use of NSAIDs in high risk groups and 14% decline in use of antipsychotics in dementia. Interventions targeting combinations of medicines, including medicine interactions and potentially inappropriate medicines in the elderly did not change practice significantly. Interventions with combinations of messages targeting multiple components of practice had an impact on one component, but not all components targeted.RESULTS12 interventions were included; three to increase medicine use, seven which aimed to reduce use, and two which had combination of messages to change use. All programs that aimed to increase medicine use were effective, with relative effect sizes at the time of the intervention ranging from 1% to 8%. Mixed results were seen with programs aiming to reduce inappropriate medicine use. Highly specific programs were effective, with relative effect sizes at the time of the intervention of 10% decline in use of NSAIDs in high risk groups and 14% decline in use of antipsychotics in dementia. Interventions targeting combinations of medicines, including medicine interactions and potentially inappropriate medicines in the elderly did not change practice significantly. Interventions with combinations of messages targeting multiple components of practice had an impact on one component, but not all components targeted.The Veterans' MATES program showed positive practice change over time, with interventions increasing use of appropriate medicines where under-use was evident and reduced use of inappropriate medicines when single medicines were targeted. Combinations of messages were less effective, suggesting specific messages focusing on single medicines are required to maximise effect. The program provides a model that could be replicated in other settings.CONCLUSIONSThe Veterans' MATES program showed positive practice change over time, with interventions increasing use of appropriate medicines where under-use was evident and reduced use of inappropriate medicines when single medicines were targeted. Combinations of messages were less effective, suggesting specific messages focusing on single medicines are required to maximise effect. The program provides a model that could be replicated in other settings. Background The Australian Government Department of Veterans' Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and related health services, which implements interventions that include audit and feedback in the form of patient-specific feedback generated from administrative claims records. We aimed to determine changes in medicine use as a result of the program. Methods The program provides targeted patient-specific feedback to medical practitioners. The feedback is supported with educational material developed by a clinical panel, subject to peer review and overseen by a national editorial committee. Veterans who meet target criteria also receive educational brochures. The program is supported by a national call centre and ongoing national consultation. Segmented regression analyses (interrupted time series) were undertaken to assess changes in medication use in targeted veterans pre and post each intervention. Results 12 interventions were included; three to increase medicine use, seven which aimed to reduce use, and two which had combination of messages to change use. All programs that aimed to increase medicine use were effective, with relative effect sizes at the time of the intervention ranging from 1% to 8%. Mixed results were seen with programs aiming to reduce inappropriate medicine use. Highly specific programs were effective, with relative effect sizes at the time of the intervention of 10% decline in use of NSAIDs in high risk groups and 14% decline in use of antipsychotics in dementia. Interventions targeting combinations of medicines, including medicine interactions and potentially inappropriate medicines in the elderly did not change practice significantly. Interventions with combinations of messages targeting multiple components of practice had an impact on one component, but not all components targeted. Conclusions The Veterans' MATES program showed positive practice change over time, with interventions increasing use of appropriate medicines where under-use was evident and reduced use of inappropriate medicines when single medicines were targeted. Combinations of messages were less effective, suggesting specific messages focusing on single medicines are required to maximise effect. The program provides a model that could be replicated in other settings. Keywords: Health promotion, Quality improvement, Quality use of medicines, Translational research, Clinical audit, Evidence-based practice The Australian Government Department of Veterans' Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and related health services, which implements interventions that include audit and feedback in the form of patient-specific feedback generated from administrative claims records. We aimed to determine changes in medicine use as a result of the program. The program provides targeted patient-specific feedback to medical practitioners. The feedback is supported with educational material developed by a clinical panel, subject to peer review and overseen by a national editorial committee. Veterans who meet target criteria also receive educational brochures. The program is supported by a national call centre and ongoing national consultation. Segmented regression analyses (interrupted time series) were undertaken to assess changes in medication use in targeted veterans pre and post each intervention. 12 interventions were included; three to increase medicine use, seven which aimed to reduce use, and two which had combination of messages to change use. All programs that aimed to increase medicine use were effective, with relative effect sizes at the time of the intervention ranging from 1% to 8%. Mixed results were seen with programs aiming to reduce inappropriate medicine use. Highly specific programs were effective, with relative effect sizes at the time of the intervention of 10% decline in use of NSAIDs in high risk groups and 14% decline in use of antipsychotics in dementia. Interventions targeting combinations of medicines, including medicine interactions and potentially inappropriate medicines in the elderly did not change practice significantly. Interventions with combinations of messages targeting multiple components of practice had an impact on one component, but not all components targeted. The Veterans' MATES program showed positive practice change over time, with interventions increasing use of appropriate medicines where under-use was evident and reduced use of inappropriate medicines when single medicines were targeted. Combinations of messages were less effective, suggesting specific messages focusing on single medicines are required to maximise effect. The program provides a model that could be replicated in other settings. The Australian Government Department of Veterans' Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and related health services, which implements interventions that include audit and feedback in the form of patient-specific feedback generated from administrative claims records. We aimed to determine changes in medicine use as a result of the program. The program provides targeted patient-specific feedback to medical practitioners. The feedback is supported with educational material developed by a clinical panel, subject to peer review and overseen by a national editorial committee. Veterans who meet target criteria also receive educational brochures. The program is supported by a national call centre and ongoing national consultation. Segmented regression analyses (interrupted time series) were undertaken to assess changes in medication use in targeted veterans pre and post each intervention. 12 interventions were included; three to increase medicine use, seven which aimed to reduce use, and two which had combination of messages to change use. All programs that aimed to increase medicine use were effective, with relative effect sizes at the time of the intervention ranging from 1% to 8%. Mixed results were seen with programs aiming to reduce inappropriate medicine use. Highly specific programs were effective, with relative effect sizes at the time of the intervention of 10% decline in use of NSAIDs in high risk groups and 14% decline in use of antipsychotics in dementia. Interventions targeting combinations of medicines, including medicine interactions and potentially inappropriate medicines in the elderly did not change practice significantly. Interventions with combinations of messages targeting multiple components of practice had an impact on one component, but not all components targeted. The Veterans' MATES program showed positive practice change over time, with interventions increasing use of appropriate medicines where under-use was evident and reduced use of inappropriate medicines when single medicines were targeted. Combinations of messages were less effective, suggesting specific messages focusing on single medicines are required to maximise effect. The program provides a model that could be replicated in other settings. Doc number: 514 Abstract Background: The Australian Government Department of Veterans' Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and related health services, which implements interventions that include audit and feedback in the form of patient-specific feedback generated from administrative claims records. We aimed to determine changes in medicine use as a result of the program. Methods: The program provides targeted patient-specific feedback to medical practitioners. The feedback is supported with educational material developed by a clinical panel, subject to peer review and overseen by a national editorial committee. Veterans who meet target criteria also receive educational brochures. The program is supported by a national call centre and ongoing national consultation. Segmented regression analyses (interrupted time series) were undertaken to assess changes in medication use in targeted veterans pre and post each intervention. Results: 12 interventions were included; three to increase medicine use, seven which aimed to reduce use, and two which had combination of messages to change use. All programs that aimed to increase medicine use were effective, with relative effect sizes at the time of the intervention ranging from 1% to 8%. Mixed results were seen with programs aiming to reduce inappropriate medicine use. Highly specific programs were effective, with relative effect sizes at the time of the intervention of 10% decline in use of NSAIDs in high risk groups and 14% decline in use of antipsychotics in dementia. Interventions targeting combinations of medicines, including medicine interactions and potentially inappropriate medicines in the elderly did not change practice significantly. Interventions with combinations of messages targeting multiple components of practice had an impact on one component, but not all components targeted. Conclusions: The Veterans' MATES program showed positive practice change over time, with interventions increasing use of appropriate medicines where under-use was evident and reduced use of inappropriate medicines when single medicines were targeted. Combinations of messages were less effective, suggesting specific messages focusing on single medicines are required to maximise effect. The program provides a model that could be replicated in other settings. BACKGROUND: The Australian Government Department of Veterans' Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and related health services, which implements interventions that include audit and feedback in the form of patient-specific feedback generated from administrative claims records. We aimed to determine changes in medicine use as a result of the program. METHODS: The program provides targeted patient-specific feedback to medical practitioners. The feedback is supported with educational material developed by a clinical panel, subject to peer review and overseen by a national editorial committee. Veterans who meet target criteria also receive educational brochures. The program is supported by a national call centre and ongoing national consultation. Segmented regression analyses (interrupted time series) were undertaken to assess changes in medication use in targeted veterans pre and post each intervention. RESULTS: 12 interventions were included; three to increase medicine use, seven which aimed to reduce use, and two which had combination of messages to change use. All programs that aimed to increase medicine use were effective, with relative effect sizes at the time of the intervention ranging from 1% to 8%. Mixed results were seen with programs aiming to reduce inappropriate medicine use. Highly specific programs were effective, with relative effect sizes at the time of the intervention of 10% decline in use of NSAIDs in high risk groups and 14% decline in use of antipsychotics in dementia. Interventions targeting combinations of medicines, including medicine interactions and potentially inappropriate medicines in the elderly did not change practice significantly. Interventions with combinations of messages targeting multiple components of practice had an impact on one component, but not all components targeted. CONCLUSIONS: The Veterans' MATES program showed positive practice change over time, with interventions increasing use of appropriate medicines where under-use was evident and reduced use of inappropriate medicines when single medicines were targeted. Combinations of messages were less effective, suggesting specific messages focusing on single medicines are required to maximise effect. The program provides a model that could be replicated in other settings. Background The Australian Government Department of Veterans’ Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and related health services, which implements interventions that include audit and feedback in the form of patient-specific feedback generated from administrative claims records. We aimed to determine changes in medicine use as a result of the program. Methods The program provides targeted patient-specific feedback to medical practitioners. The feedback is supported with educational material developed by a clinical panel, subject to peer review and overseen by a national editorial committee. Veterans who meet target criteria also receive educational brochures. The program is supported by a national call centre and ongoing national consultation. Segmented regression analyses (interrupted time series) were undertaken to assess changes in medication use in targeted veterans pre and post each intervention. Results 12 interventions were included; three to increase medicine use, seven which aimed to reduce use, and two which had combination of messages to change use. All programs that aimed to increase medicine use were effective, with relative effect sizes at the time of the intervention ranging from 1% to 8%. Mixed results were seen with programs aiming to reduce inappropriate medicine use. Highly specific programs were effective, with relative effect sizes at the time of the intervention of 10% decline in use of NSAIDs in high risk groups and 14% decline in use of antipsychotics in dementia. Interventions targeting combinations of medicines, including medicine interactions and potentially inappropriate medicines in the elderly did not change practice significantly. Interventions with combinations of messages targeting multiple components of practice had an impact on one component, but not all components targeted. Conclusions The Veterans’ MATES program showed positive practice change over time, with interventions increasing use of appropriate medicines where under-use was evident and reduced use of inappropriate medicines when single medicines were targeted. Combinations of messages were less effective, suggesting specific messages focusing on single medicines are required to maximise effect. The program provides a model that could be replicated in other settings. |
| ArticleNumber | 514 |
| Audience | Academic |
| Author | Peck, Robert Gilbert, Andrew L Roughead, Elizabeth E Kalisch Ellett, Lisa M Killer, Graeme Barratt, John D LeBlanc, Vanessa T Ramsay, Emmae N Ryan, Philip Pratt, Nicole L |
| AuthorAffiliation | 2 Data Management and Analysis Centre, Discipline of Public Health, University of Adelaide, Adelaide, Australia 1 Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia, Adelaide, Australia 3 Department of Veterans’ Affairs, Canberra, Australia |
| AuthorAffiliation_xml | – name: 1 Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia, Adelaide, Australia – name: 3 Department of Veterans’ Affairs, Canberra, Australia – name: 2 Data Management and Analysis Centre, Discipline of Public Health, University of Adelaide, Adelaide, Australia |
| Author_xml | – sequence: 1 givenname: Elizabeth E surname: Roughead fullname: Roughead, Elizabeth E organization: Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia – sequence: 2 givenname: Lisa M surname: Kalisch Ellett fullname: Kalisch Ellett, Lisa M email: lisa.kalisch@unisa.edu.au organization: Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia – sequence: 3 givenname: Emmae N surname: Ramsay fullname: Ramsay, Emmae N organization: Data Management and Analysis Centre, Discipline of Public Health, University of Adelaide – sequence: 4 givenname: Nicole L surname: Pratt fullname: Pratt, Nicole L organization: Data Management and Analysis Centre, Discipline of Public Health, University of Adelaide – sequence: 5 givenname: John D surname: Barratt fullname: Barratt, John D organization: Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia – sequence: 6 givenname: Vanessa T surname: LeBlanc fullname: LeBlanc, Vanessa T organization: Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia – sequence: 7 givenname: Philip surname: Ryan fullname: Ryan, Philip organization: Data Management and Analysis Centre, Discipline of Public Health, University of Adelaide – sequence: 8 givenname: Robert surname: Peck fullname: Peck, Robert organization: Department of Veterans’ Affairs – sequence: 9 givenname: Graeme surname: Killer fullname: Killer, Graeme organization: Department of Veterans’ Affairs – sequence: 10 givenname: Andrew L surname: Gilbert fullname: Gilbert, Andrew L organization: Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/24330781$$D View this record in MEDLINE/PubMed |
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| Copyright | Roughead et al.; licensee BioMed Central Ltd. 2013 This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. COPYRIGHT 2013 BioMed Central Ltd. 2013 Roughead et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2013 Roughead et al.; licensee BioMed Central Ltd. 2013 Roughead et al.; licensee BioMed Central Ltd. |
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| Keywords | Clinical audit Quality improvement Translational research Health promotion Quality use of medicines Evidence-based practice |
| Language | English |
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publication-title: Pharmacoepidemiol Drug Saf doi: 10.1002/pds.1536 – volume: 44 start-page: 1175 year: 1989 end-page: 1184 ident: CR10 article-title: Human agency in social cognitive theory publication-title: Am Psychol doi: 10.1037/0003-066X.44.9.1175 – year: 2012 ident: CR8 publication-title: Veterans' Medicines Advice and Therapeutics Education Services (Veterans' MATES) – year: 1995 ident: CR28 publication-title: Health program planning, An educational and ecological approach – volume: 41 start-page: 316 issue: 4 year: 2011 ident: 2936_CR9 publication-title: J Pharm Pract Res doi: 10.1002/j.2055-2335.2011.tb00112.x – volume: 13 start-page: 83 year: 2004 ident: 2936_CR3 publication-title: Pharmacoepidemiol Drug Saf doi: 10.1002/pds.912 – volume-title: Social foundations of thought and action: a social cognitive theory year: 1986 ident: 2936_CR11 – volume: 27 start-page: 885 issue: 11 year: 2010 ident: 2936_CR25 publication-title: Drugs Aging doi: 10.2165/11584490-000000000-00000 – 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volume: 44 start-page: 1175 year: 1989 ident: 2936_CR10 publication-title: Am Psychol doi: 10.1037/0003-066X.44.9.1175 – volume-title: Health program planning, an educational and ecological approach year: 1995 ident: 2936_CR14 – volume-title: International statistical classification of diseases and related health problems 10th revision year: 2002 ident: 2936_CR17 – volume-title: Principles of best practice for clinical audit year: 2002 ident: 2936_CR27 – volume: 163 start-page: 2716 year: 2003 ident: 2936_CR33 publication-title: Arch Intern Med doi: 10.1001/archinte.163.22.2716 – volume: 190 start-page: 114 year: 2009 ident: 2936_CR21 publication-title: Med J Aust doi: 10.5694/j.1326-5377.2009.tb02307.x – volume: 6 start-page: 661 issue: 6 year: 2006 ident: 2936_CR5 publication-title: Expert Review of Pharmacoeconomics and Outcomes Research doi: 10.1586/14737167.6.6.661 – volume: 58 start-page: 107 issue: 2 year: 2005 ident: 2936_CR1 publication-title: J Clin Epidemiol doi: 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14662625 - Arch Intern Med. 2003 Dec 8-22;163(22):2716-24 – reference: 16625533 - Cochrane Database Syst Rev. 2006;(2):CD000259 – reference: 19203305 - Med J Aust. 2009 Feb 2;190(3):114-6 – reference: 15680740 - J Clin Epidemiol. 2005 Feb;58(2):107-12 – reference: 2782727 - Am Psychol. 1989 Sep;44(9):1175-84 – reference: 21442685 - Pharmacoepidemiol Drug Saf. 2011 Apr;20(4):359-65 – reference: 18098333 - Pharmacoepidemiol Drug Saf. 2008 Feb;17(2):160-71 – reference: 14998069 - Pharmacoepidemiol Drug Saf. 2004 Feb;13(2):83-7 – reference: 20964462 - Drugs Aging. 2010 Nov 1;27(11):885-93 – reference: 20528492 - Expert Rev Pharmacoecon Outcomes Res. 2006 Dec;6(6):661-71 – reference: 17046966 - Health Promot Int. 2007 Mar;22(1):53-64 |
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| Snippet | Background
The Australian Government Department of Veterans’ Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and... The Australian Government Department of Veterans' Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and related health... Background The Australian Government Department of Veterans' Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and... Doc number: 514 Abstract Background: The Australian Government Department of Veterans' Affairs (DVA) funds an ongoing health promotion based program to improve... BACKGROUND: The Australian Government Department of Veterans' Affairs (DVA) funds an ongoing health promotion based program to improve use of medicines and... |
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| SubjectTerms | Analysis Audits Australia Call centers Consumer organizations Dementia Drug stores Drug Therapy - methods Drug Therapy - standards Drug therapy, Combination Drugs Educational materials Equipment and supplies Evidence-based medicine Evidence-Based Practice - education Evidence-Based Practice - organization & administration Evidence-Based Practice - standards Feedback Health Administration Health aspects Health care reform Health Informatics Health promotion Health services Humans Inappropriate Prescribing - prevention & control Inappropriate Prescribing - statistics & numerical data Intervention Medical Audit Medicine Medicine & Public Health Nursing Research Pharmaceuticals Pharmacists Physical fitness Practice Patterns, Physicians' - standards Practice Patterns, Physicians' - statistics & numerical data Public Health Quality Quality improvement Quality Improvement - organization & administration Research Article safety and outcomes Teaching Veterans Veterans - statistics & numerical data |
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| Title | Bridging evidence-practice gaps: improving use of medicines in elderly Australian veterans |
| URI | https://link.springer.com/article/10.1186/1472-6963-13-514 https://www.ncbi.nlm.nih.gov/pubmed/24330781 https://www.proquest.com/docview/1470150157 https://www.proquest.com/docview/1490717715 http://dx.doi.org/10.1186/1472-6963-13-514 https://pubmed.ncbi.nlm.nih.gov/PMC3878826 |
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