Managing appropriate prescribing in primary care COPD patients with comorbidities: Evaluation of an IPCRG Desktop Helper in a pragmatic cluster randomized controlled trial

1. Research questionWill an intervention with the IPCRG Desktop Helper (number 10) with or without a supporting e-learning module reduce medication-comorbidity clashes? 2. BackgroundOver 85% of COPD patients have one or more comorbidities. Depending on a patient’s specific comorbidity, medications for the treatment of COPD may be contra-indicated, as a result of drug-disease interactions. The Desktop Helper (number 10) of the International Primary Care Respiratory Group (IPCRG) is a tool for GPs to identify potential contra-indicated medications. The Desktop Helper can be feasibly built in the Electronic Medical Records system of the GP practice to facilitate case finding of COPD patients with multimorbidities and drugs not recommended due to the comorbidities. 3. Possible methodology A four-arm pragmatic cluster randomized controlled trial will be conducted in GP practices in the Netherlands. The control condition (arm 1: care as usual) will be compared with three intervention arms (i.e. arm 2: the ‘Desktop Helper (number 10)’, arm 3: an e-learning module, and arm 4: the ‘Desktop Helper (number 10)’ and the e-learning module). In total 38 GP practices will be recruited, 9 in each arm.The Desktop Helper includes 11 clinical rules to enable the identification of COPD patients with multimorbidity and drugs not recommended due to comorbidity and to provide clinical decision support. The e-learning provides more information regarding COPD and comorbidities and the relevant medication-comorbidity clashes and gives advice regarding the case-finding. At baseline and at 26 weeks, a data-extraction of comorbidities and prescribed medications will be obtained from the Electronic Medical Records of participating GP practices. 4. Questions to discussWould this study design be relevant in your country?Would you implement this in your practice? Why? Should the Desktop Helper be implemented in treatment guidelines?Do you think the Desktop Helper is of added value for your clinical practice? Declaration of Interest This study is funded by Boehringer Ingelheim the Netherlands. Clinical trial registration number: NTC04539457 References and Clinical Trial Registry Information Clinical trial registration number: NTC04539457