An evaluation of educational outreach to improve evidence‐based prescribing in Medicaid: a cautionary tale

Zillich, Alan J.; Ackermann, Ronald T.; Stump, Timothy E.; Ambuehl, Roberta; Downs, Steven M.; Holmes, Ann M.; Katz, Barry P.; Inui, Thomas S.

doi:10.1111/j.1365-2753.2008.01035.x

Cited by 16 publications

(21 citation statements)

References 29 publications

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“…Demonstrating the effectiveness of interventions to improve the appropriate use of polypharmacy in older patients is hardly achievable in clinical practice, especially when performing educational meetings/workshops, which can have small or even unproven benefit . In fact, the latest Cochrane review concluded that ‘ It is unclear whether interventions to improve appropriate polypharmacy , such as pharmaceutical care , resulted in clinically significant improvement ’ .…”

Section: Discussionmentioning

confidence: 99%

“…In the recent past, administrative databases have been largely used to estimate the prevalence of DDIs as well as to determine possible predictors/determinants of DDI occurrence, especially in elderly under poly‐therapy . However, only a limited number of studies have attempted to assess the impact of educational campaigns to improve appropriateness of clinicians' prescriptions, with a non‐significant effect of educational outreach programmes on the prescribing rate of potential DDIs .…”

Section: Introductionmentioning

confidence: 99%

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Clinically important drug–drug interactions in poly‐treated elderly outpatients: a campaign to improve appropriateness in general practice

Raschi¹,

Piccinni²,

Signoretta

et al. 2015

Brit J Clinical Pharma

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Aims The aim was to assess the impact of a campaign for general practitioners (GPs) to reduce clinically‐important drug–drug interactions (DDIs) in poly‐treated elderly patients. Methods We compiled a list of 53 DDIs and analyzed reimbursed prescriptions dispensed to poly‐treated (≥four drugs) elderly (>65 years) patients in the Emilia Romagna region during January 2011–June 2011 (first pre‐intervention period), January 2012–June 2012 (second pre‐intervention period) and January 2013–June 2013 (post‐intervention period). Educational initiatives to GPs were completed in July 2012–December 2012. Pre‐test/post‐test analysis (2013 vs. 2012) was performed, also using predicted 2013 data (P < 0.01 for statistical significance). Results Despite the slight increase in poly‐therapy rate (16% in 2013, +1.5% from 2011), we found a stable or slightly declining number of potential DDIs for each elderly poly‐treated patient (~1.5). In 2013, 11 DDIs exceeded 5% of prevalence rate: antidiabetics‐β‐adrenoceptor blockers ranked first (20.3%), followed by ACE Inhibitors (ACEIs)/sartans‐non steroidal anti‐inflammatory drugs (NSAIDs) (16.4%), diuretics‐NSAIDs (13.6%), selective serotonin re‐uptake inhibitors (SSRIs)‐NSAIDs/acetyl salicylic acid (ASA) (12.7%) and corticosteroids‐NSAIDs/ASA (9.7%). A remarkable reduction emerged for NSAID‐related DDIs (diuretics‐NSAIDs peaked −14.5%; P < 0.01), whereas prevalence of antidiabetics‐β‐adrenoceptor blockers increased (+7.9%; P < 0.01). When using predicted values, the statistical significance disappeared for antidiabetics‐β‐adrenoceptor blockers (+1.3%; P = 0.04), whereas it persisted for almost all NSAIDs‐related DDIs: ACEIs/sartans‐NSAIDs (−3.0%), diuretics‐NSAIDs (−6.0%), SSRIs‐NSAIDs/ASA (−5.9%). Conclusions This campaign contained the burden of DDIs in poly‐treated elderly patients by 1) reducing most prevalent DDIs, especially NSAIDs‐related DDIs and 2) balancing the observed rise in poly‐therapy rate with stable rate in overall prescriptions of potentially interacting drugs per patient.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinically important drug–drug interactions in poly‐treated elderly outpatients: a campaign to improve appropriateness in general practice

Raschi¹,

Piccinni²,

Signoretta

et al. 2015

Brit J Clinical Pharma

View full text Add to dashboard Cite

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“…Evidence from studies of approaches to improving adequacy and/or promoting the reduction or abandonment of low-value pharmacological prescribing shows, on the one hand, that training in isolation does not have an effect in terms of de-implementing inappropriate prescribing. On the other, multi-component interventions that combine multiple tailored interventions (audit and feedback, alert systems and clinical decision support systems) have achieved more positive results [16][17][18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Addressing low-value pharmacological prescribing in primary prevention of CVD through a structured evidence-based and theory-informed process for the design and testing of de-implementation strategies: the DE-imFAR study

Sánchez

Pijoán

Pablo

et al. 2019

Preprint

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Background: De-implementation or abandonment of ineffective or low-value healthcare is becoming a priority research field globally due to the growing empirical evidence of the high prevalence of such care and its impact in terms of patient safety and social inefficiency. Little is known, however, about the factors, barriers and facilitators involved or about interventions that are effective in promoting and accelerating the de-implementation of low-value healthcare. The De-imFAR study seeks to carry out a structured, evidence-based and theory-informed process involving the main stakeholders (clinicians, managers, patients and researchers) for the design, deployment and assessment of de-implementation strategies for reducing low-value pharmacological prescribing.Methods: A Phase I formative study using a systematic and comprehensive framework based on theory and evidence for the design of implementation strategies – specifically, the Behavior Change Wheel (BCW) - will be conducted to design and model de-implementation strategies to favour reductions in low-value pharmacological prescribing of statins in primary prevention of cardiovascular disease (CVD) by main stakeholders (clinicians, managers, patients and researchers) in a collegiate way. Subsequently, a Phase II comparative hybrid trial will be conducted to assess the feasibility and potential effectiveness of at least one active de-implementation strategy to reduce low-value pharmacological prescribing of statins in primary prevention of CVD compared to the usual procedures for dissemination of clinical practice guidelines ("what-not-to-do" recommendations). A mixed methods evaluation will be used: quantitative for the results of the implementation at the professional level (e.g., adoption, reach and implementation or execution of the recommended clinical practice); and qualitative to determine the feasibility and perceived impact of the de-implementation strategies from the clinicians’ perspective, and patients’ experiences related to the clinical care received.Discussion: The DE-imFAR study aims to generate valid scientific knowledge about the design and development of de-implementation strategies using theory- and evidence-based methodologies suggested by implementation science. It will explore the effectiveness of these strategies and their acceptability among clinicians, policy makers and patients. Its ultimate goal is to maximize the quality and efficiency of our health system by abandoning low-value pharmacological prescribing.

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“…Previous systematic reviews reported that passive interventions, such as including unsolicited mailings, are not as effective as active interventions, such as academic detailing. 34,[38][39][40][41][42] No previously published subject reviews have examined the comparative effectiveness of various types of printed materials alone. The purpose of this review is to evaluate the effectiveness of mailed intervention programs that used primarily printed techniques and identify factors that have been associated with successful outcomes.…”

Section: S U B J E C T R E V I E Wmentioning

confidence: 99%

Improving the Success of Mailed Letter Intervention Programs to Influence Prescribing Behaviors: A Review

Ho¹,

Venci²

2012

JMCP

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BACKGROUND: Educational interventions have long been used as a means of influencing prescribing behavior. Various techniques including educational mailings, academic detailing, prescriber feedback with or without disclosing patient-identifying data, and supplemental patient information have been used to promote appropriate prescribing habits, reduce costs, and optimize patient care. While the effects of educational intervention programs are widely reported, little information is available regarding the effectiveness of various mailed intervention techniques.

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An evaluation of educational outreach to improve evidence‐based prescribing in Medicaid: a cautionary tale

Cited by 16 publications

References 29 publications

Clinically important drug–drug interactions in poly‐treated elderly outpatients: a campaign to improve appropriateness in general practice

Clinically important drug–drug interactions in poly‐treated elderly outpatients: a campaign to improve appropriateness in general practice

Addressing low-value pharmacological prescribing in primary prevention of CVD through a structured evidence-based and theory-informed process for the design and testing of de-implementation strategies: the DE-imFAR study

Improving the Success of Mailed Letter Intervention Programs to Influence Prescribing Behaviors: A Review

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