Measuring prescribing improvements in pragmatic trials of educational tools for general practitioners
Measuring prescribing improvements in pragmatic trials of educational tools for general practitioners
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DOI：
10.1111/j.1742-7843.2006.pto_301.x
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发表时间：
2006-03-01
影响因子：
3.1
通讯作者：
Schneeweiss, S
中科院分区：
文献类型：
--
作者：
Maclure, M;Nguyen, A;Schneeweiss, S
需要对药物进行随机化的实用性试验、医生教育和药物政策，以改善药物监测和处方的成本效益。自1994年以来，我们开发和测试了低成本教育和政策试验的方法，以改善加拿大初级保健的处方。我们回顾了使用药物索赔和其他卫生服务数据来评估处方改进计划和政策的方法。我们将这些经验应用于医生教育工具（PET）的拟议试验，以提高处方质量。试验的设计问题包括使用反事实在因果方面定义潜在的项目，缩小受影响人群的分母，从分子中排除噪音，计算处方偏好，调整基线差异，控制修饰语和混杂因素，在测量影响时考虑不确定性，以及对反馈和认可的实践进行分组。一项关于学术细节的随机试验的数据说明了测量方面的挑战。十年来，在用药物索赔数据评估处方改进方案的方法方面取得了进展，这使得加拿大能够规划初级保健教育和政策的常规随机务实试验。
Randomized pragmatic trials of drugs, physician education and drug policies are needed to improve pharmacosurveillance and cost-effectiveness of prescribing. Since 1994, we have developed and tested methods for low-cost education and policy trials to improve prescribing in primary care in Canada. We review methodology for using drug claims and other health services data to evaluate prescribing improvement programs and policies. We apply the lessons to a proposed trial of physician education tools (PET) for quality improvement of prescribing. Design issues for the trial include defining the potential programme in causal terms using counterfactuals, narrowing the denominator to the population affected, excluding noise from the numerator, calculating the prescribing preference, adjusting for baseline differences, controlling for modifiers and confounders, accounting for uncertainty when measuring impacts, and grouping practices for feedback and recognition. Data from a randomized trial of academic detailing illustrate measurement challenges. A decade of progress on methods for evaluating prescribing improvement programs with drug claims data has enabled planning of routine randomized pragmatic trials of education and policies in primary care in Canada.