Effectiveness of educational interventions on the improvement of drug prescription in primary care: a critical literature review

Abstract

This paper is a critical review of studies of educational programmes designed to improve prescription practices in ambulatory care. Scientific articles were selected from the following bibliographical indices: MEDLINE, IME, ICYT and ERIC. The searches covered the time period between 1988 and 1997. The search criteria included: primary-care, educat*, prescription* and other related keywords. The inclusion criteria were studies describing educational strategies aimed at general practitioners working in ambulatory settings. The study outcome was change in prescribing behaviour of physicians through prescribing indicators. The following data were extracted: study design, target drugs, type of intervention, follow-up period of the prescription trends, type of data analysis, type of statistical analysis and reported results. We found 3233 articles that met the search criteria. Of these, 51 met the inclusion criteria and 43 studied the efficacy/effectiveness of one or various interventions as compared to no intervention. Among seven studies evaluating active strategies, four reported positive results (57%), as opposed to three of the eight studies assessing passive strategies (38%). Among the 28 studies that tested reinforced active strategies, 16 reported positive results for all variables (57%). Eight studies were classified as a high degree of evidence (16%). We concluded that the results of our review suggest that the more personalized, the more effective the strategies are. We observe that combining active and passive strategies results in a decrease of the failure rate. Finally, better studies are still needed to enhance the efficacy and efficiency of prescribing practices.

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

“…5,6,28,30,32,[43][44][45] This is consistent with the findings by Figueiras et al (2001), who concluded that interventions that were personalized to recipients were associated with a higher rate of success. 34 If costs permit, addition of pharmacists and/or patients as recipients may further improve intervention success. Additionally, interventions that consisted of educational materials alone rarely had an impact on prescribing practice.…”

“…26,31,32 The impact of educational intervention programs and retrospective drug utilization review has been widely reported in the literature. [33][34][35][36][37] Intuitively, we expect that unsolicited printed materials would improve prescribing patterns, but it is difficult to quantify its association to improved clinical outcomes or health care resource costs. Previous systematic reviews reported that passive interventions, such as including unsolicited mailings, are not as effective as active interventions, such as academic detailing.…”

“…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.…”

“…Evaluations of mailed intervention programs alone have produced mixed results, and little information is available regarding the comparative effectiveness of various mailed intervention strategies. • Figueiras et al (2001) noted interventions that engage prescribers in personal contact ("active intervention") are more effective than those that provide unsolicited mailed materials ("passive intervention"). The authors concluded that combining active and passive strategies and formulating materials to be personalized to the recipient appeared to be the most effective intervention design.…”

Evaluación de un programa de educación médica continua para la atención primaria en la prescripción de hipoglucémicos

“…De los resultados de estas experiencias se puede inferir que las medidas de mayores efectos son las que incluyen múltiples intervenciones, así como las que tienen un enfoque didáctico interactivo y promueven la participación activa de los médicos, por ejemplo auditorías de casos con sesiones de retroalimentación, recordatorios computarizados y asesorías en consultorio. [1][2][3][4] En el Instituto Mexicano del Seguro Social (IMSS) se han realizado de forma permanente programas de educación médica, las más de las veces con técnicas educativas tradicionales de enfoque casi siempre pasivo. En el año 2002 se instituyó un programa con enfoque participativo dirigido a los médicos familiares en relación con los seis principales motivos de consulta en Unidades de Medicina Familiar (UMF): diabetes tipo 2, hipertensión arterial, infecciones respiratorias agudas, vigilancia del desarrollo del niño, atención prenatal y cervicovaginitis.…”