Physician responses to an educational intervention on improving their long-term prescribing of sedatives

Sleath, Betsy; Collins, Ted

doi:10.1016/s0738-3991(97)00029-3

Cited by 5 publications

(12 citation statements)

References 17 publications

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“…15 Several authors noted that it may be difficult to prompt discontinuation of agents that have been used on a long-term basis; this may be particularly true for sedative hypnotics. 13,24,29,48 One report found that patient demand deterred 26% of prescribers from intervening on long-term use of sedative agents. 48 Additionally, both prescribers and patients may have a decreased perception of potential harm associated with agents that have been used on a long-term basis.…”

Section: Target Medicationsmentioning

confidence: 99%

“…13,24,29,48 One report found that patient demand deterred 26% of prescribers from intervening on long-term use of sedative agents. 48 Additionally, both prescribers and patients may have a decreased perception of potential harm associated with agents that have been used on a long-term basis. 29 Aside from the potential impact of chronic use, there appeared to be no difference in success rates between interventions that recommended initiation or discontinuation of a medication.…”

Section: Target Medicationsmentioning

confidence: 99%

“…Twenty-one of the 25 programs that provided some form of patient-identifying data were considered to have a significant impact on prescribing. [2][3][4][7][8][9][10][11][12][13][14][15][16][18][19][20][21][22][23]25,48 It should be noted that Meyer et al considered their patient-identifying intervention to be unsuccessful because changes in prescribing patterns were no longer significant at 6 and 12 months postintervention.…”

Section: Target Medicationsmentioning

confidence: 99%

“…49 Most programs that used patient-identifying data opted to make generalized recommendations that could be applicable to their entire target population. [2][3][4][7][8][9][10][11][12][13][14]16,[18][19][20][21][22][23][24][25]48,49 For example, the intervention conducted by alerted physicians of the identified patient's potential for acetaminophen overuse, discussed the associated risks, and suggested adjusting therapy to meet recommended daily standards. 12 Such a method appears to be an effective intervention tactic, as 20 of 22 programs (90.1%) that provided this type of recommendation were successful.…”

Section: Target Medicationsmentioning

confidence: 99%

“…Response rate among reporting programs ranged from 25% to nearly 90%. 2,9,10,12,14,18,20,21,27,29,32,46,[48][49][50] Generally, recipients viewed the intervention positively and often indicated intent to alter therapy based on the materials received. The majority of programs that reassessed patient profiles following response from mailings reported that an actual change in therapy occurred in approximately 50% of patients whose prescriber indicated intent to modify treatment.…”

Section: Zuckerman Et Al (2004)mentioning

confidence: 99%

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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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Section: Target Medicationsmentioning

confidence: 99%

Section: Target Medicationsmentioning

confidence: 99%

Section: Target Medicationsmentioning

confidence: 99%

Section: Target Medicationsmentioning

confidence: 99%

Section: Zuckerman Et Al (2004)mentioning

confidence: 99%

See 3 more Smart Citations

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

Ho¹,

Venci²

2012

JMCP

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

Figueiras

Sastre

Gestal

2001

Evaluation Clinical Practice

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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.

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Dexmedetomidine

Coursin¹,

Coursin

Maccioli

2001

Current Opinion in Critical Care

252

176

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Effective use of sedative-hypnotic and analgesic agents is an integral part of providing patient comfort and safety. Of the numerous drugs administered, benzodiazepines, propofol, and narcotics are the most popular. Even these proven, time-tested sedative-hypnotics and analgesics are not perfect, however, and modern intensive care demands a more ideal product. The development of dexmedetomidine, an alpha2-agonist, is an attempt to improve sedative/analgesic use and provide a drug that possesses the characteristics outlined in Table 1. It stimulates alpha2-adrenergic receptors in the locus ceruleus to provide sedation and in the spinal cord to enhance analgesia. It also causes sympatholysis via central and peripheral mechanisms. Dexmedetomidine binds alpha2-receptors eight times more avidly than clonidine and is shorter acting. It was initially evaluated as an anesthetic, but was associated with excessive bradycardia and hypertension, followed by hypotension. In late 1999, dexmedetomidine was approved for adult ICU use for less than 24 hours as a sedative infusion. It currently lacks approval in Europe. Most of the clinical experience with dexmedetomidine has been with surgical patients undergoing cardiac and vascular procedures. Careful patient selection and proper drug infusion are needed to avoid excessive deleterious hemodynamic results. Slower bolus loading over 20 minutes results in minimally decreased heart rate and blood pressure. Continuous infusion maintains unique sedation (patients appear to be asleep, but are readily roused), analgesic sparing effect, and minimal depression of respiratory drive. More experience with dexmedetomidine infusion in medical ICU patients and patients with complex end-organ dysfunction such as respiratory failure or systemic inflammatory response syndrome is needed before conclusions can be drawn about the drug's potential for wider application and its long-term (> 24 h) safety and effectiveness.

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Physician responses to an educational intervention on improving their long-term prescribing of sedatives

Cited by 5 publications

References 17 publications

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

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

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

Dexmedetomidine

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