Preliminary experiences with a single-patient trials service in general practice

Med J Aust. 2000 Jul 17;173(2):100-3.

Abstract

Objective: To pilot a single-patient trials (SPTs) service in general practice, designed to improve decision-making about long-term medications for chronic conditions.

Design: 12-week within-patient, randomised, double-blind, placebo-controlled, crossover comparison of ibuprofen with paracetamol for osteoarthritis, involving three pairs of two-week treatment periods for each participating patient.

Setting and patients: Patients attending an academic general practice with a clinical diagnosis of osteoarthritis, with pain of at least a month's duration severe enough to warrant consideration of long-term non-steroidal anti-inflammatory drug (NSAID) use.

Main outcome measures: Pain and stiffness; measures of overall arthritis compared with previous fortnight; preference for NSAID at the end of each two-week treatment period; use of escape analgesia; side effects; and management changes as a result of the SPTs.

Results: Eight of 14 patients completed SPTs. One was a clear responder to NSAIDs, five were non-responders, and two were indefinite. Of the five who were using NSAIDs' before the SPT, two continued and three ceased using them. Clinically useful information assisted decision-making for all eight participants. Medication management changed for six.

Conclusions: Single-patient trials can be successfully implemented in general practice and might be a valuable method for GPs to identify patients who respond to medication for chronic stable conditions such as osteoarthritis, in which individual response to medication is variable.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetaminophen / therapeutic use
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics, Non-Narcotic / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Chronic Disease / drug therapy*
  • Cross-Over Studies
  • Decision Making*
  • Double-Blind Method
  • Family Practice*
  • Female
  • Humans
  • Ibuprofen / therapeutic use
  • Male
  • Middle Aged
  • Osteoarthritis / drug therapy
  • Pilot Projects
  • Randomized Controlled Trials as Topic / methods*
  • Sample Size*

Substances

  • Analgesics, Non-Narcotic
  • Anti-Inflammatory Agents, Non-Steroidal
  • Acetaminophen
  • Ibuprofen