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Financial incentives reduce high-risk prescribing, say researchers

Financial incentives for GPs reduce high-risk prescribing of NSAIDs and antiplatelet medications, claim researchers.

The team from the University of Dundee provided GP practices with informatics, education and financial incentives over a 48-week ‘intervention’ period. 

They found there was a reduction of high-risk prescribing in patients that were vulnerable to adverse drug events related to NSAIDs and antiplatelet agents.

The effect was also sustained for a further 48 weeks following the initial 48-hour intervention.

Total high-risk prescribing fell by 1.5% after the intervention, while the likelihood of rates of high-risk prescribing reduced by 37% compared with the practice’s behaviour pre-intervention.

Emergency hospital admissions for gastrointestinal events preceded by a high-risk prescription related to NSAIDs and antiplatelet medication were 34% more likely to fall, compared with the pre-intervention period.

The risk of being admitted to hospital with gastrointestinal bleeding or acute kidney injury fell by 91% and 68% respectively, but the researchers say the reductions seen are larger than can be explained by the present study.

The intervention – carried out at 33 practices in Scotland – consisted of an education programme that featured newsletters and a visit from a pharmacist, as well as financial incentives and a computer informatics system that flagged at-risk patients needing review.

The study, published in The New England Journal of Medicine, concludes that the significant and sustained reductions seen in the study prove the effectiveness of the intervention.

Writing in the paper, the researchers state: ‘In conclusion, we found that a complex intervention that combined professional education, informatics to support patient identification and review, and financial incentives to review patients who have been exposed to high-risk prescribing led to substantial and sustained reductions in targeted high-risk prescribing and was associated with reductions in the rates of related emergency admissions.’



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