Consequences of Doing What Should Not be Done in Primary Care

Study Overview
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Brief Summary
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Retrospective observational study in a random selection of 5% of digital records active between 2014 and 2017 to quantify the frequency of Do not do primary care recommendations, calculating the over-cost related to them and study reviewing a random selection of cases previously identified to determine whether patient suffered adverse events and their over-cost.

Detailed Description
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Basement: Overuse subjected patients to unnecessary risk without promoting a sufficient clinical benefit and over-cost. The Less is More Medicine movement has led to the identification of Do not do in different specialties, also in primary care. Objective: To analyze the impact of errors (overuse rates based in Do not do recommendations) in clinical practice. Method: Retrospective observational study in a random selection of 5% of digital records active between 2014 and 2017 to quantify the frequency of Do not do primary care recommendations, calculating the over-cost related to them. Retrospective study reviewing a random selection of cases previously identified to determine whether patient suffered adverse events and their over-cost. Setting. Primary care in Andalucía, Aragón, Castilla La Mancha, Comunidad Valenciana, Madrid, Murcia, Navarra y País Vasco, eight autonomous communities in Spain.

Official Title
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Consequences of Doing What Should Not be Done in Primary Care

Conditions
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Overdose, Adverse Event

Intervention / Treatment
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* Drug: Benzodiazepines
* Drug: Non-steroidal anti-inflammatory drugs
* Drug: paracetamol
* Drug: Antimicrobial agent
* Drug: Lipid-lowering drug
* Diagnostic Test: Prostate cancer
* Radiation: Lumbago
* Drug: Antimicrobial agent
* Drug: Mucolytic
* Drug: Ibuprofen and paracetamol


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients visiting GPs Exclusion Criteria: None
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients visiting GP<br>All patients visiting GP. The frequency of some drugs and diagnosis tests include in the Do-Not-Do recommendations will be analyzed. | Drug: Benzodiazepines<br>* Benzodiazepines for insomnia, agitation or delirium in people older than 65<br>Drug: Non-steroidal anti-inflammatory drugs<br>* Non-steroidal anti-inflammatory drugs in patients with cardiovascular disease, chronic kidney disease, hypertension, heart failure or liver cirrhosis<br>Drug: paracetamol<br>* paracetamol 1g for more than 3 days<br>Drug: Antimicrobial agent<br>* antibiotic in acute bronchitis when the patient does not suffer from COPD, heart failure, diabetes or kidney disease or is undergoing active chemotherapy<br>* Other names: Antibiotics;Drug: Lipid-lowering drug<br>* Lipid-lowering drugs in patients older than 75 years without previous cardiovascular events<br>Diagnostic Test: Prostate cancer<br>* Screening for prostate cancer in asymptomatic patients<br>Radiation: Lumbago<br>* image tests in non-specific lumbago<br>|
| Patient visiting pediatricians<br>All patients visiting pediatricians (0 to 14 years old). The frequency of some drugs and diagnosis tests include in the Do-Not-Do recommendations will be analyzed. | Drug: Antimicrobial agent<br>* antibiotics for pharyngitis (infants)<br>* Other names: Antibiotics;Drug: Mucolytic<br>* mucolytics, antitussives or antibiotics for upper respiratory infections (infants)<br>* Other names: Mucolytics;Drug: Ibuprofen and paracetamol<br>* treatment with ibuprofen and paracetamol (infants)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Medical overuse | Inadequate prescriptions of antimicrobials, mucolytics, lipid-lowering-drugs, ibuprofen or paracetamol in some specific cases defined as overuse | Three years | 
| Medical overuse | Inadequate test for lumbalgia or prostate cancer | Three years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adverse events as consequence of inadequate clinical decision [Safety] | Patients suffering hurt due to inadequate prescription or inadequate test. Inadequate prescriptions or tests as defined by Do-not-Do recommendations. These were defined by Spanish Primary Care Scientific Societies | Three years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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patient safety, quality assurance, overuse