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Quality assurance for drug prescribing
S B Soumerai1, T J McLaughlin, J Avorn
1Harvard Medical School, Department of Social Medicine, Boston, MA 02115.
Quality Assurance in Health Care : the Official Journal of the International Society for Quality Assurance in Health Care
|January 1, 1990
Summary
Effective physician education programs improve prescribing behavior. Face-to-face outreach and feedback with specific suggestions are most impactful for enhancing drug prescribing quality and reducing costs.
Area of Science:
- Health Services Research
- Medical Education
- Pharmacoeconomics
Background:
- Physician prescribing behavior significantly impacts healthcare costs and patient outcomes.
- Previous evaluations focused on hospital settings; this study critically analyzes primary care interventions.
- A significant portion of studies on physician education lack rigorous research design standards.
Purpose of the Study:
- To critically analyze English-language studies on interventions aimed at improving physician prescribing behavior in primary care.
- To identify effective strategies for enhancing the quality and appropriateness of drug prescribing.
- To confirm findings from previous evaluations of hospital-based prescribing interventions.
Main Methods:
- Critical analysis of English-language studies meeting minimum research design standards.
- Categorization of interventions including printed materials, computerized data, reminder systems, feedback, tutorials, and outreach visits.
- Focus on studies conducted in primary care settings.
Main Results:
- Dissemination of printed educational materials alone showed no effect.
- Computerized listings without recommendations were ineffective.
- Continuous computerized reminders can prevent omission of essential care but haven't been evaluated for reducing inappropriate prescribing.
- Repeated feedback with suggestions increased generic drug use; tutorials improved antibiotic and hypertension management.
- Face-to-face educational outreach visits by pharmacists or physician leaders effectively reduced prescribing of inefficient or contraindicated drugs.
Conclusions:
- Face-to-face educational outreach is a highly effective strategy for improving physician prescribing in primary care.
- Interventions must be personalized and provide specific, actionable recommendations for optimal impact.
- Well-designed educational programs can improve prescribing quality and potentially lead to cost savings that exceed program expenses.