Educational interventions to improve prescribing competency: a systematic review

Abstract

ObjectiveTo review the literature on educational interventions to improve prescribing and identify educational methods that improve prescribing competency in both medical and non-medical prescribers.DesignA systematic review was conducted. The databases Medline, International Pharmaceutical Abstracts (IPA), EMBASE and CINAHL were searched for articles in English published between January 1990 and July 2013.SettingPrimary and secondary care.ParticipantsMedical and non-medical prescribers.InterventionEducation-based interventions to aid improvement in prescribing competency.Primary outcomeImprovements in prescribing competency (knows how) or performance (shows how) as defined by Miller's competency model. This was primarily demonstrated through prescribing examinations, changes in prescribing habits or adherence to guidelines.ResultsA total of 47 studies met the inclusion criteria and were included in the systematic review. Studies were categorised by their method of assessment, with 20 studies assessing prescribing competence and 27 assessing prescribing performance. A wide variety of educational interventions were employed, with different outcome measures and methods of assessments. In particular, six studies demonstrated that specific prescribing training using the WHO Guide to Good Prescribing increased prescribing competency in a wide variety of settings. Continuing medical education in the form of academic detailing and personalised prescriber feedback also yielded positive results. Only four studies evaluated educational interventions targeted at non-medical prescribers, highlighting that further research is needed in this area.ConclusionsA broad range of educational interventions have been conducted to improve prescribing competency. The WHO Guide to Good Prescribing has the largest body of evidence to support its use and is a promising model for the design of targeted prescribing courses. There is a need for further development and evaluation of educational methods for non-medical prescribers.

Non-medical prescribing assessment – An evaluation of a nationally agreed multi method approach

“…Practice based scenarios have been reported in the non-medical prescribing literature (Forward and Hayward, 2005) however a recent systematic review of 47 articles (Kamarudin et al, 2013) noted none of the non-medical prescribing studies assessed competence in 'live' prescribing scenarios; instead, they assessed practice in a simulated environment. This assessment method was introduced to non-medical prescribing programmes in Scotland in 2007, takes place in practice with a service user and is assessed by the DMP.…”

Effect of educational intervention on the knowledge and attitude on prescribing amongst interns of a tertiary care hospital: a questionnaire based study

“…In this study the knowledge of interns' regarding Prescription writing has presented a marked increase after subjecting them to an educational intervention which goes in hand with the study results of the systematic review done by Kamrudeen, et al 6 This study stands unique in its way, as we have assessed the knowledge and attitude of the Interns' on prescribing, both before and after the educational intervention and also gave hands on training on rational prescribing and audited the same.…”

“…A systematic review of 47 studies done by Gritta Kamrudeen, et al has suggested that prescribing performance and competence can be significantly improved by training with WHO Guide to good prescribing as guide and by giving feedback to the prescriber which can be also be enhanced by continuing medical education giving academic details. 6 Errors in prescription by not adhering to the WHO guidelines regarding core indicators have been expressed in many prescription audit studies among practicing physicians and also by interns during their Primary Health centres postings. With this background the present cross sectional study was organized.…”

Evaluation of hands on training on prescription writing skills among medical students in a tertiary care teaching hospital

“…[35] In the systematic review done by Kamarudin et al, it was suggested that educational interventional sessions were useful in improving the prescribing competencies of the medical students, by training them with the WHO guide to good prescribing. [36] Introducing a standard prescribing chart, educating, and training the prescribers, conducting regular prescription writing exercises and prescription auditing workshops followed by clinical discussions are some of the measures which will help inculcate the habit of writing a rational prescription. [6] Educational interventional sessions should be combined with giving feedback to the prescribers, as this will give an opportunity for them to learn from their mistakes and will also increase the effectiveness of learning.…”