Systematic Review of Interventions to Improve Prescribing
Systematic Review of Interventions to Improve Prescribing
Objective: To update 2 comprehensive reviews of systematic reviews on prescribing interventions and identify the latest evidence about the effectiveness of the interventions.
Data Sources: Systematic searches for English-language reports of experimental and quasi-experimental research were conducted in PubMed (1951–May 2007), EMBASE (1974–March 2008), International Pharmaceutical Abstracts (1970–March 2008), and 11 other bibliographic databases of medical, social science, and business research. Following an initial title screening process and after selecting 6 specific intervention categories (identified from the previous reviews) in community settings, 2 reviewers independently assessed abstracts and then full studies for relevance and quality and extracted relevant data using formal assessment and data extraction tools. Results were then methodically incorporated into the findings of the 2 earlier reviews of systematic reviews.
Data Selection and Synthesis: Twenty-nine of 26,314 articles reviewed were assessed to be of relevant, high-quality research. Audit and feedback, together with educational outreach visits, were the focus of the majority of recent, high-quality research into prescribing interventions. These interventions were also the most effective in improving prescribing practice. A smaller number of studies included a patient-mediated intervention; this intervention was not consistently effective. There is insufficient recent research into manual reminders to confidently update earlier reviews and there remains insufficient evidence to draw conclusions regarding the effectiveness of local consensus processes or multidisciplinary teams.
Conclusions: Educational outreach as well as audit and feedback continue to dominate research into prescribing interventions. These 2 prescribing interventions also most consistently show positive results. Much less research is conducted into other types of interventions and there is still very little effort to systematically test why interventions do or do not work.
Introduction
Improved decision-making about drug prescribing by clinicians could lead to significant improvements in patient outcomes and effective use of healthcare expenditure. Even with recent improvements in the dissemination of evidence into practice (eg, through initiatives like the Cochrane Collaboration [www.cochrane.org] and Australia's National Prescribing Service [www.nps.org.au]), there remains variation in prescribing practice among medical practitioners. Given this variation and the potential for harm from newer drugs that have sometimes limited advantage over existing drugs, it is important that we understand which interventions have been effective in changing prescribing in ways that optimize patient outcomes while minimizing healthcare costs.
The need for more informed prescribing is reinforced by current and future factors affecting the delivery of health care. These include an aging population, projected increases in the population with chronic disease, changing consumer expectations, more comprehensive undergraduate and continuing health professional education, and an explosion of knowledge about health and greater access to information via the Internet. In an ever-changing healthcare environment, it is important to ensure that interventions used to improve prescribing continue to have the desired impact and that new, carefully evaluated methods of influencing prescribing are adopted.
The aim of this project was to conduct a systematic literature review of current published research, building on past systematic reviews that identified interventions/strategies that are likely to encourage the adoption of appropriate, safe, and cost-effective prescribing.
Abstract and Introduction
AbstractObjective: To update 2 comprehensive reviews of systematic reviews on prescribing interventions and identify the latest evidence about the effectiveness of the interventions.
Data Sources: Systematic searches for English-language reports of experimental and quasi-experimental research were conducted in PubMed (1951–May 2007), EMBASE (1974–March 2008), International Pharmaceutical Abstracts (1970–March 2008), and 11 other bibliographic databases of medical, social science, and business research. Following an initial title screening process and after selecting 6 specific intervention categories (identified from the previous reviews) in community settings, 2 reviewers independently assessed abstracts and then full studies for relevance and quality and extracted relevant data using formal assessment and data extraction tools. Results were then methodically incorporated into the findings of the 2 earlier reviews of systematic reviews.
Data Selection and Synthesis: Twenty-nine of 26,314 articles reviewed were assessed to be of relevant, high-quality research. Audit and feedback, together with educational outreach visits, were the focus of the majority of recent, high-quality research into prescribing interventions. These interventions were also the most effective in improving prescribing practice. A smaller number of studies included a patient-mediated intervention; this intervention was not consistently effective. There is insufficient recent research into manual reminders to confidently update earlier reviews and there remains insufficient evidence to draw conclusions regarding the effectiveness of local consensus processes or multidisciplinary teams.
Conclusions: Educational outreach as well as audit and feedback continue to dominate research into prescribing interventions. These 2 prescribing interventions also most consistently show positive results. Much less research is conducted into other types of interventions and there is still very little effort to systematically test why interventions do or do not work.
Introduction
Improved decision-making about drug prescribing by clinicians could lead to significant improvements in patient outcomes and effective use of healthcare expenditure. Even with recent improvements in the dissemination of evidence into practice (eg, through initiatives like the Cochrane Collaboration [www.cochrane.org] and Australia's National Prescribing Service [www.nps.org.au]), there remains variation in prescribing practice among medical practitioners. Given this variation and the potential for harm from newer drugs that have sometimes limited advantage over existing drugs, it is important that we understand which interventions have been effective in changing prescribing in ways that optimize patient outcomes while minimizing healthcare costs.
The need for more informed prescribing is reinforced by current and future factors affecting the delivery of health care. These include an aging population, projected increases in the population with chronic disease, changing consumer expectations, more comprehensive undergraduate and continuing health professional education, and an explosion of knowledge about health and greater access to information via the Internet. In an ever-changing healthcare environment, it is important to ensure that interventions used to improve prescribing continue to have the desired impact and that new, carefully evaluated methods of influencing prescribing are adopted.
The aim of this project was to conduct a systematic literature review of current published research, building on past systematic reviews that identified interventions/strategies that are likely to encourage the adoption of appropriate, safe, and cost-effective prescribing.
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