What interventions should pharmacists employ to impact health practitioners' prescribing practices?
Kelly A Grindrod, Payal Patel, Janet E Martin. What interventions should pharmacists employ to impact health practitioners' prescribing practices? Annals of Pharmacotherapy 2006; 40:1546-57
Drug therapies prescribed by physicians do not always align with the best available clinical evidence. Pharmacists help bridge this gap by reviewing medication orders and by influencing prescribing practices of physicians. Interventions employed by pharmacists could be reminders, audit and feedback, educational outreach visits, organizational efforts, and patient-mediated strategies. The primary objective of this systematic review was to investigate which interventions are most effective in influencing physicians’ prescribing practices. This systematic review attempts to synthesize data from multiple systematic studies in this area in order to identify trends, limit bias and improve reliability of results. This study was a systematic review of 34 systematic reviews published after 1994. The results of this study indicate that
- Reminders (manual and computerized), audit and feedback, educational outreach visits, organizational strategies and patient-mediated interventions were consistently effective i.e. they were effective in more than 70% of the clinical trials described within the systematic reviews under study
- Computer decision support systems and educational meetings were inconsistently effective interventions i.e. were effective in 50-69% of clinical trials
- Didactic sessions and passive dissemination of information were of uncertain effectiveness i.e. they were effective in less than 50% of the clinical trials.
- Multifaceted interventions such as audit and feedback in combination with either reminders or academic detailing are determined to be more effective that single interventions
- There was insufficient evidence to draw conclusions regarding the effect of interventions on patient outcomes. Of 12 systematic reviews that were examined the effect on patient outcomes, 8 showed positive results of these interventions.
Rapidly emerging new information about efficacy, risks and cost effectiveness of drug therapies requires pharmacists to play an increasingly important role in optimizing patient care and in guiding physicians’ prescribing practices. This study will help pharmacists to select the most effective strategies that can maximize the limited time and resources at their disposal.
Further studies that determine the impact of drug programs by employing restrictive policies such as formularies and limited reimbursements should be encouraged to clearly demonstrate their effectiveness.
The results of this systematic review are ambiguous about the impact of computerized decision support systems (CDSS) on prescribing practices. One study determined that CDSS that provided recommendations at the point of decision making was the most effective form of reminder for impacting clinician’s prescribing behavior. Another study also found that the effect of computer generated reminders decreased once this intervention was discontinued. But four other systematic reviews found CDSS to be inconsistently useful in impacting medication dosing and preventive care system. As CDSS systems mature and are widely adopted, more studies need to be undertaken to disambiguate the role of CDSS in influencing prescribing practices of physicians.