Using n-of-1 trials as a clinical tool to improve prescribing

Nikles, C. J., Clavarino, A. M. and Del Mar, C. B. (2005) Using n-of-1 trials as a clinical tool to improve prescribing. British Journal Of General Practice, 55 512: 175-180.


Author Nikles, C. J.
Clavarino, A. M.
Del Mar, C. B.
Title Using n-of-1 trials as a clinical tool to improve prescribing
Journal name British Journal Of General Practice   Check publisher's open access policy
ISSN 0960-1643
Publication date 2005-03
Sub-type Article (original research)
Volume 55
Issue 512
Start page 175
End page 180
Total pages 6
Editor Jewell, D.
Place of publication London, U.K.
Publisher Royal College General Practitioners
Collection year 2005
Language eng
Subject C1
321208 Primary Health Care
730199 Clinical health not specific to particular organs, diseases and conditions
Formatted abstract
Background
N-of-1 trials are within-patient, randomised, double-blind, placebo-controlled cross-over comparisons of two drugs for chronic illnesses. We have investigated the use of these, offered to doctors as individualised medication effectiveness tests (IMETs), as a tool to improve drug prescribing.
Aim
To examine patient perspectives and experiences of n-of-1 trials.
Design of study
We provided n-of-1 trials for osteoarthritis (OA), comparing paracetamol and ibuprofen; and attention deficit hyperactivity disorder (ADHD), comparing dexamphetamine or methylphenidate and placebo. Patients or their carers were surveyed before and after the trials by questionnaire, and after the trial by semi-structured interview with thematic analysis.
Setting
Australian community-based patients and practitioners.
Method
Forty-two patients with OA and 21 carers of patients with ADHD, for whom the effectiveness of proposed or existing medication was uncertain, completed the questionnaires, and 25 patients/carers (11 with OA and 14 with ADHD) participated in semi-structured interviews.
Results
Patients in this purposive sample were generally very satisfied with the n-of-1 trial process. Their participation led to increased knowledge, awareness and understanding of their condition, their bodies' response to it, and its management. Some of this arose specifically from use of daily symptom diaries. This led to a sense of empowerment and control as well as improved individually-focused care.
Conclusions
N-of-1 trials appeared to empower these patients as a result of both collecting information about their responses to different treatment options, and participating actively in subsequent therapeutic decisions. They are a patient-centred intervention that may improve medication management in suitable chronic diseases.
Keyword attention deficit hyperactivity disorder
osteoarthritis
patient-centred care
Drug
Medication
Outcomes
Care
Involvement
Disease
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2006 Higher Education Research Data Collection
School of Pharmacy Publications
 
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Created: Wed, 15 Aug 2007, 05:48:44 EST