Cough and cold medicine prescription rates can be significantly reduced by active intervention

Abstract

Our aim was to construct and test an intervention programme to eradicate cough and cold medicine (CCM) prescriptions for children treated in a nationwide healthcare service company. The study was carried out in the largest private healthcare service company in Finland with a centralised electronic health record system allowing for real-time, doctor-specific practice monitoring. The step-by-step intervention consisted of company-level dissemination of educational materials to doctors and families, educational staff meetings, continuous monitoring of prescriptions, and targeted feedback. Outreach visits were held in noncompliant units. Finally, those physicians who most often prescribed CCM were directly contacted. During the intervention period (2017–2020), there were more than one million paediatric visits. Prescriptions of CCMs to children were completely eradicated in 41% of units and the total number of CCM prescriptions decreased from 6738 to 744 (89%). During the fourth intervention year, CCMs containing opioid derivatives were prescribed for only 0.2% of children aged < 2 years. The decrease in prescriptions was greatest in general practitioners (5.2 to 1.1%). In paediatricians, the prescription rates decreased from 1.5 to 0.2%. The annual costs of CCMs decreased from €183,996 to €18,899 (89.7%). For the intervention, the developers used 343 h and the attended doctors used 684 h of work time during the 4-year intervention. The costs used for developing, implementing, reporting, evaluating, communicating, and data managing formed approximately 11% of total intervention costs.Conclusion: The study showed that a nationwide systematic intervention to change cough medicine prescription practices is feasible and requires only modest financial investments. What is Known:• Cough and cold medicines (CCM) are not effective or safe, especially for children aged 6 years.• Although the use of CCMs has been declining, caregivers continue to administer CCMs to children, and some physicians still prescribe them even for preschool children. What is New:• A nationwide systematic intervention can significantly and cost effectively change CCM prescription habits of paediatricians, general practitioners, and other specialists.• Electronic health records provide additional tools for operative guideline implementation and real-time quality monitoring, including recommendations of useless or harmful treatments.

Antibiotic prescriptions for children with lower respiratory tract infections fell from 2014 to 2020, but misuse was still an issue

“…The participants diagnosed CAP in 301 children who were treated with antibiotics, and 94.1% of patients over age 5 years received antibiotics in accordance with the guidelines, compared with 78.6% in controls. The nationwide electronic health record system used by all doctors of the present study provides a suitable template for doctor‐specific education and feedbacks containing real‐time clinical data, including data on prescriptions, as was successfully used to reduce cough medicine prescriptions for children 24,25 . Based on our results, active interventions should not only target the use of appropriate therapy but also improving differential diagnosis of LRTIs in children.…”

Electronic health record databases provide a platform for intervention studies

“…The authors of one Finnish study constructed, and tested, an intervention programme to reduce prescriptions for cough and cold medication. The cohort comprised children who were treated by a nationwide healthcare service company that used a centralised EHR that enabled it to monitor the clinical practices of specific doctors in real time 10 …”

“…The total cost of the four‐year intervention for the company was about the same as the amount the parents spent on cough and cold medication during the last year. The study showed that a nationwide systematic intervention to reduce such prescriptions was feasible and only required modest financial investments and an online EHR system with coded data 10 …”

“…real time. 10 The step-by-step intervention consisted of disseminating educational materials to doctors and families, educational staff meetings, continuously monitoring prescriptions and targeting feedback. Outreach visits were held in non-compliant units.…”

“…The study showed that a nationwide systematic intervention to reduce such prescriptions was feasible and only required modest financial investments and an online EHR system with coded data. 10 So far, national public and private databases have mainly been used for data collection for retrospective studies, rather than prospective clinical interventions. For example, the national electronic prescription database used in Finland could also be used for online monitoring of age-specific and medication-specific initiatives.…”