NCD drugs have a critical role in attaining universal health coverage, which ensures access to effective, highquality and affordable health services (3). According to the framework introduced by WHO, there are 4 factors that affect access to medicines: rational selection and
BackgroundPhysician prescribing is the most frequent medical intervention with a highest impact on healthcare costs and outcomes. Therefore improving and promoting rational drug use is a great interest. We aimed to assess the effectiveness and cost-effectiveness of two forms of conducting prescribing audit and feedback interventions and a printed educational material intervention in improving physician prescribing.Method/designA four-arm randomized trial with economic evaluation will be conducted in Tehran. Three interventions (routine feedback, revised feedback, and printed educational material) and a no intervention control arm will be compared. Physicians working in outpatient practices are randomly allocated to one of the four arms using stratified randomized sampling. The interventions are developed based on a review of literature, physician interviews, current experiences in Iran and with theoretical insights from the Theory of Planned Behavior. Effects of the interventions on improving antibiotics and corticosteroids prescribing will be assessed in regression analyses. Cost data will be assessed from a health care provider’s perspective and incremental cost-effectiveness ratios will be calculated.DiscussionThis study will determine the effectiveness and cost-effectiveness of three interventions and allow us to determine the most effective interventions in improving prescribing pattern. If the interventions are cost-effective, they will likely be applied nationwide.Trial registrationIranian Registry of Clinical Trials Registration Number: IRCT201106086740N1Pharmaceutical Sciences Research Center of TUMS Ethics Committee Registration Number: 90-02-27-07
An economic crisis has been defined as a situation in which the scale of a country's economy becomes smaller in a period of time. Economic crises happen for various reasons, including economic sanctions. Economic crises in a country may affect national priorities for investment and expenditure and reduce available resources, and hence may affect the health care sector including access to medicines. We reviewed the pharmaceutical policies that the countries adopted in order to mitigate the potential negative effects on access to medicines. We reviewed published reports and articles after conducting a comprehensive search of the PubMed and the Google Scholar. After extracting relevant data from the identified articles, we used the World Health Organization (WHO) access to medicines framework as a guide for the categorization of the policies. We identified a total of 40 studies, of which 10 reported the national pharmaceutical policies adopted to reduce the negative impacts of economic crises on access to medicines in high-income and middle-income countries. We identified 89 policies adopted in the 11 countries and categorized them into 12 distinct policy directions. Most of the policies focused on financial aspects of the pharmaceutical sector. In some cases, countries adopted policies that potentially had negative effects on access to medicines. Only Italy had adopted policies encompassing all four accesses to medicine factors recommended by the WHO. While the countries have adopted many seemingly effective policies, little evidence exists on the effectiveness of these policies to improve access to medicines at a time of an economic crisis.
Overprescribing of antibiotics and injectable medicines is common in ambulatory care in many low-and middleincome countries. We evaluated the effects of three different interventions in improving physician prescribing. We conducted a four-armed randomized controlled trial with one-month and three-months follow-up. General physicians, pediatricians, and infectious disease specialists were included in this study if they had an outpatient office in Tehran, Iran. The study involved two behaviorally guided interventions: Bnew-design audit and feedback (NA&F)^; Bprinted educational material (PEM)^and an existing intervention of Broutinely conducted audit and feedback (RA&F)^. The theoretical framework underpinning the intervention was the theory of planned behavior. Main outcome measures were the percentage change in the proportion of prescriptions containing injectable dexamethasone; oral amoxicillin and cefixime. NA&F reduced the proportion of prescriptions particularly those containing dexamethasone injectable and cefixime (1.64, 0.99 absolute percentage change, p = 0.006, p = 0.01 respectively). PEM reduced the proportion of prescriptions containing cefixime (0.93 absolute percentage change p = 0.04). Other primary outcomes had no significant differences. A secondary outcome measure showed overall prescribing of injectables also reduced (absolute risk reduction: 3%). Overally, the study provides strong evidence that using theoretical insights in the development of the intervention improved prescribing behavior that lasted at least three months after the intervention. The design, format, and presentation of messages in feedback forms significantly influence the impact of audit and feedback on physician prescribing. While the interventions were effective, the impacts on inappropriate prescribing were modest and limited. In settings with rampant problems of overprescribing, intensive interventions are required to substantially improve prescribing patterns.
Objectives: Improving and promoting rational drug use is a great interest. We aimed to assess the effectiveness and cost-effectiveness of prescribing audit and feedback intervention in improving physician prescribing. MethOds: A four-arm randomized trial with economic evaluation conducted in Tehran. Three interventions (routine feedback, revised feedback, and printed educational material) and a no intervention control arm compared. Physicians working in outpatient practices were randomly allocated to one of the four arms using stratified randomized sampling. The interventions were developed based on a review of literature, physician interviews, current experiences in Iran and with theoretical insights from the Theory of Planned Behavior. Effects of the interventions on improving antibiotics and corticosteroids prescribing assessed in regression analyses. Cost data assessed from a health care provider's perspective and incremental cost-effectiveness ratios calculated. Results: Comparing the new-design feedback arm and the no intervention arm, we observed significant reductions in the proportion of prescriptions including Dexamethasone injectable (1.64 difference in percentage change; p value: 0.006) and Cefixime (0.99 difference in percentage change; p value: 0.01). We also observed significant reductions in the printed educational material arm's proportion of prescriptions including Cefixime (0.93 difference in percentage change; p value: 0.04) as compared with the no intervention arm. ICER values corresponding to Dexamethasone injectable and Cefixime were 0.41 and 1.03 US$ per unit reduction in the number of prescriptions respectively. cOnclusiOns: According to the results of this study, we recommend that a careful attention to the format, design and the way the messages are conveyed in feedback forms is an important indicator of audit and feedback's potential success in improving prescribing behavior. Considering the incremental cost-effectiveness ratio, the cost-effectiveness of new-design feedback intervention arm has been proved.Objectives: Analyzing all randomized controlled trials (RCTs) published in The Lancet in 2013 to to discuss the influence factors on the publication of high-quality clinical studies. MethOds: We included all RCTs published in The Lancet in 2013. The information about the research topic and the number of included participants, the first author's region and type of research institution, and the participants' region were collected, and analyzed their proportions. Results: 110 eligible RCTs with 734,085 participants were included. The top three topics of the RCTs were infectious diseases 22 (20.0%), cardiology and vascular medicine 17 (15.5%), oncology 12 (10.9%), but the top three number of participants were 210,350 (28.7%) in obstetrics and gynaecology, 198,471 (27.0%) in oncology, and 154,637 (21.1%) in infectious diseases. The proportion of RCTs which enrolled participants from developed countries is 86.4%, only 13.6% ones enrolled participants in developing countries. The first auth...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.