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

Objective: To pilot a single-patient trials (SPTs) service in general pract ice, designed to improve decision-making about long-term medications for ch ronic conditions. Design: 12-week within-patient, randomised, double-blind, placebo-controlle d, crossover comparison of ibuprofen with paracetamol for osteoarthritis, i nvolving three pairs of two-week treatment periods for each participating p atient. Setting and patients: Patients attending an academic general practice with a clinical diagnosis of osteoarthritis, with pain of at least a month's dur ation severe enough to warrant consideration of long-term non-steroidal ant i-inflammatory drug (NSAID) use. Main outcome measures: Pain and stiffness; measures of overall arthritis co mpared with previous fortnight; preference for NSAID at the end of each two -week treatment period; use of escape analgesia; side effects; and manageme nt 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 part icipants. Medication management changed for six. Conclusions: Single-patient trials can be successfully implemented in gener al 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.