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Drug Safety

, Volume 36, Issue 7, pp 557–564 | Cite as

The Impact of Direct Healthcare Professional Communication on Prescribing Practice in the UK Hospital Setting: An Interrupted Time Series Analysis

  • Sarah K. Thomas
  • James Hodson
  • Graham McIlroy
  • Annjeet Dhami
  • Jamie J. ColemanEmail author
Original Research Article

Abstract

Background

Direct Healthcare Professional Communications (DHPCs) aim to quickly disseminate information to key healthcare professionals to inform practice and minimize patient harm. The Medicines and Healthcare products Regulatory Agency (MHRA) issues warnings and alerts to communicate safety information effectively in the UK.

Objective

To investigate the impact of MHRA DHPCs on prescribing practice in the secondary-care setting, looking specifically at a drug-drug interaction–the concomitant use of clopidogrel and proton pump inhibitors (PPIs) [as omeprazole]–and a drug-disease contraindication–the use of conventional (typical) antipsychotics in dementia.

Methods

The effects of the MHRA DHPCs were analysed using segmented binary logistic regression of interrupted time series. This allowed for the detection of any significant changes in prescribing practice occurring after the MHRA warnings were issued, whilst controlling for the baseline period.

Results

Of the patients concomitantly prescribed clopidogrel and omeprazole on admission, the rate at which omeprazole was substituted for either another PPI (with the exception of esomeprazole), or for a histamine H2-antagonist showed a significant step-change increase after the DHPC was issued. The modelled rate increased from 5.1 % in the month directly before the intervention to 25.1 % in the following month (odds ratio [OR] 6.18; p < 0.001). However, the action taken in the switching of therapy was not always consistent with the advice from the current MHRA warning. The rate of typical antipsychotic prescribing in patients with dementia was declining significantly by 3.9 % per quarter prior to the DHPC being issued (OR 0.970; p = 0.035). No significant step-change was detected immediately after the DHPC (p = 0.962). However, the rate of decline increased significantly in the post-warning period to 12.3 % per quarter (OR 0.938; p = 0.006).

Conclusion

This study has shown that DHPCs issued by the MHRA as warnings are associated with changes in prescribing practices in secondary care. However, their impact is variable depending on the intervention described by the warning. A national initiative to ensure patient safety information is effectively translated into practice and the effect of the warning continues beyond the period of the issue would be beneficial.

Keywords

Dementia Clopidogrel Omeprazole Esomeprazole Interrupted Time Series 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We would like to thank the Data Analysts, David Westwood and Mariam Afzal, for obtaining the information from the PICS and LORENZO systems in order to carry out this research.

Statements of contribution

All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. All authors contributed to the writing of the manuscript, the interpretation of data, and approved the final version.

Competing interests

Jamie Coleman is a member of the Pharmacovigilance Expert Advisory Group of the MHRA. The views expressed in this study are, however, his own.

Funding

This work was funded by the National Institute for Health Research (NIHR) through the Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country (CLAHRC-BBC) programme. The views expressed in this study are not necessarily those of the NIHR, the Department of Health, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham or the CLAHRC-BBC Theme 9 Management Steering Group.

Conflict of interest

Sarah Thomas, James Hodson, Graham McIlroy, Annjeet Dhami and Jamie Coleman have no conflicts of interest to declare that are directly relevant to the content of this study.

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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Sarah K. Thomas
    • 1
    • 2
  • James Hodson
    • 1
    • 2
  • Graham McIlroy
    • 1
  • Annjeet Dhami
    • 1
  • Jamie J. Coleman
    • 1
    • 2
  1. 1.The Medical School, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
  2. 2.University Hospitals Birmingham NHS Foundation TrustBirminghamUK

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