The impact of evidence-based education on prescribing in a psychiatry residency

Recent clinical trials comparing the effectiveness of antipsychotics have found no advantage for second-generation antipsychotics over older first-generation agents. However, the former are much more commonly used despite their significantly higher cost and potential for contributing to the metabolic syndrome. To date, educational interventions have been unsuccessful in influencing this pattern. The Duke University Medical Center Department of Psy chiatry began a program based on principles of academic detailing designed to educate psychiatry residents about generic psychotropics. To encourage residents to gain experience with these medications, samples of selected generic drugs were provided. To assess the initiative's impact, the authors measured the prescribing patterns of residents.

We measured the amount of generic drug use 6 months after the program began and compared it with data from a 6-month control period. The data were analyzed based on overall psychotropic use, class of medication, site, and diagnosis.

We found a consistent increase in generic use across analyses. There was an increase in overall generic prescribing from 55.8% to 58.6% [X=10.37, odds ratio (OR)=1.12, P=0.0013] and a particularly large increase in prescribing of generic antipsychotic medications from 39.5% to 47.7% [X=36.12, OR=1.39, P<0.0001]. Conclusion. The implementation of this educational program was correlated with increasing use of generic medications and brought antipsychotic prescribing into concordance with the new evidence. This is the first such study in a psychiatry residency program and has implications for promoting cost-effective care while preserving patient choice in the mental health system. The findings from this study also suggest potential techniques for expanding residents' prescribing skills across specialties.