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

Ho, Mei-Jen; Venci, Jineane V.

doi:10.18553/jmcp.2012.18.8.627

Cited by 19 publications

(15 citation statements)

References 44 publications

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“…In this study, we demonstrated that mailed personalised feedback could lead to meaningful changes in prescribing behaviour of primary care prescribers. A review in 2012 reported that mailed interventions are well received by prescribers, and are able to evoke significant changes in prescribing patterns [ 30 ]. This finding is encouraging and illustrates the potential in using feedback to drive prescribing performances in primary care through benchmarking among prescribers.…”

Section: Discussionmentioning

confidence: 99%

The impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics: a cluster randomised trial

Lim

Hss

et al. 2018

BMC Fam Pract

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BackgroundTo evaluate the effectiveness of a structured prescription review and prescriber feedback program in reducing prescribing errors in government primary care clinics within an administrative region in Malaysia.MethodsThis was a three group, pragmatic, cluster randomised trial. In phase 1, we randomised 51 clinics to a full intervention group (prescription review and league tables plus authorised feedback letter), a partial intervention group (prescription review and league tables), and a control group (prescription review only). Prescribers in these clinics were the target of our intervention. Prescription reviews were performed by pharmacists; 20 handwritten prescriptions per prescriber were consecutively screened on a random day each month, and errors identified were recorded in a standardised data collection form. Prescribing performance feedback was conducted at the completion of each prescription review cycle. League tables benchmark prescribing errors across clinics and individual prescribers, while the authorised feedback letter detailed prescribing performance based on a rating scale. In phase 2, all clinics received the full intervention. Pharmacists were trained on data collection, and all data were audited by researchers as an implementation fidelity strategy. The primary outcome, percentage of prescriptions with at least one error, was displayed in p-charts to enable group comparison.ResultsA total of 32,200 prescriptions were reviewed. In the full intervention group, error reduction occurred gradually and was sustained throughout the 8-month study period. The process mean error rate of 40.7% (95% CI 27.4, 29.5%) in phase 1 reduced to 28.4% (95% CI 27.4, 29.5%) in phase 2. In the partial intervention group, error reduction was not well sustained and showed a seasonal pattern with larger process variability. The phase 1 error rate averaging 57.9% (95% CI 56.5, 59.3%) reduced to 44.8% (95% CI 43.3, 46.4%) in phase 2. There was no evidence of improvement in the control group, with phase 1 and phase 2 error rates averaging 41.1% (95% CI 39.6, 42.6%) and 39.3% (95% CI 37.8, 40.9%) respectively.ConclusionsThe rate of prescribing errors in primary care settings is high, and routine prescriber feedback comprising league tables and a feedback letter can effectively reduce prescribing errors.Trial registrationNational Medical Research Register: NMRR-12-108-11,289 (5th March 2012).Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0808-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics: a cluster randomised trial

Lim

Hss

et al. 2018

BMC Fam Pract

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“…11 Although evidence of their effectiveness is mixed, 12,13 in some settings, drug utilization review may improve prescribing practices. [14][15][16] We evaluated the impact of a physician-directed drug utilization review on the potentially inappropriate use of controlled substances among members whose claims history suggested high-risk utilization.…”

mentioning

confidence: 99%

Impact of a drug utilization review program on high‐risk use of prescription controlled substances

Daubresse

Gleason

Peng

et al. 2013

Pharmacoepidemiology and Drug

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“…These interventions show a modest but statistically significant positive effect on changing professional behaviours but the heterogeneity of the trials prevents solid conclusions to be drawn [35, 41, 46–52]. Although audit and feedback on test ordering behaviour embedded in peer review in small groups has been found to be more effective than audit and feedback alone, it generally remains unclear exactly what factors contribute to this effect [10, 21, 53, 54].…”

Section: Discussionmentioning

confidence: 99%

Effect of audit and feedback with peer review on general practitioners’ prescribing and test ordering performance: a cluster-randomized controlled trial

Trietsch¹,

Steenkiste²,

Grol³

et al. 2017

BMC Fam Pract

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BackgroundMuch research worldwide is focussed on cost containment and better adherence to guidelines in healthcare. The research focussing on professional behaviour is often performed in a well-controlled research setting. In this study a large-scale implementation of a peer review strategy was tested on both test ordering and prescribing behaviour in primary care in the normal quality improvement setting.MethodsWe planned a cluster-RCT in existing local quality improvement collaboratives (LQICs) in primary care. The study ran from January 2008 to January 2011. LQICs were randomly assigned to one of two trial arms, with each arm receiving the same intervention of audit and feedback combined with peer review. Both arms were offered five different clinical topics and acted as blind controls for the other arm. The differences in test ordering rates and prescribing rates between both arms were analysed in an intention-to-treat pre-post analysis and a per-protocol analysis.ResultsTwenty-one LQIC groups, including 197 GPs working in 88 practices, entered the trial. The intention-to-treat analysis did not show a difference in the changes in test ordering or prescribing performance between intervention and control groups. The per-protocol analysis showed positive results for half of the clinical topics. The increase in total tests ordered was 3% in the intervention arm and 15% in the control arm. For prescribing the increase in prescriptions was 20% in the intervention arm and 66% in the control group. It was observed that the groups with the highest baseline test ordering and prescription volumes showed the largest improvements.ConclusionsOur study shows that the results from earlier work could not be confirmed by our attempt to implement the strategy in the field. We did not see a decrease in the volumes of tests ordered or of the drugs prescribed but were able to show a lesser increase instead. Implementing the peer review with audit and feedback proved to be not feasible in primary care in the Netherlands.Trial RegistrationThis trial was registered at the Dutch trial register under number ISRCTN40008171 on August 7th 2007.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-017-0605-5) contains supplementary material, which is available to authorized users.

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

Cited by 19 publications

References 44 publications

The impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics: a cluster randomised trial

The impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics: a cluster randomised trial

Impact of a drug utilization review program on high‐risk use of prescription controlled substances

Effect of audit and feedback with peer review on general practitioners’ prescribing and test ordering performance: a cluster-randomized controlled trial

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