IMPROVING DRUG-THERAPY DECISIONS THROUGH EDUCATIONAL OUTREACH - A RANDOMIZED CONTROLLED TRIAL OF ACADEMICALLY BASED DETAILING
IMPROVING DRUG-THERAPY DECISIONS THROUGH EDUCATIONAL OUTREACH - A RANDOMIZED CONTROLLED TRIAL OF ACADEMICALLY BASED DETAILING
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DOI：
10.1056/nejm198306163082406
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发表时间：
1983-01-01
影响因子：
158.5
通讯作者：
SOUMERAI, SB
中科院分区：
文献类型：
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作者：
AVORN, J;SOUMERAI, SB
随着新型强效药物的扩散以及控制保健费用的经济压力日益增加，提高开处方的准确性和经济性这一目标的重要性日益增加。实施以办公室为基础的医师教育计划，以减少3组药物的过度使用：大脑和周围血管扩张剂[罂粟碱，环兰德尔酸盐，尼利德林，异苏嘌呤和海得碱]；口服头孢菌素；和丙氧芬。通过医疗补助记录确定了4个州的435名处方者，并随机分配到3组中的1组。与对照组相比，接受临床药师的个人教育访问以及一系列邮寄的非广告的医生减少了14%的目标药物处方（P = 0.0001）。在两组之间，这些药物的报销金额有相当的减少，从而节省了大量的成本。在只收到邮寄的印刷材料的医生中没有看到这种变化。这种效果在干预开始后至少持续了9个小时，并且没有发现使用昂贵替代药物的显著增加。以学术为基础的详细描述可能是一种有用且具有成本效益的方法，可以提高药物治疗决策的质量并减少不必要的支出。
Improving precision and economy in the prescribing of drugs is a goal whose importance has increased with the proliferation of new and potent agents and with growing economic pressures to contain health-care costs. An office-based physician education program was implemented to reduce the excessive use of 3 drug groups: cerebral and peripheral vasodilators [papaverine, cyclandelate, nylidrin, isoxsuprine and hydergine]; an oral cephalosporin; and propoxyphene. A 4-state sample of 435 prescribers of these drugs was identified through Medicaid records and randomly assigned to 1 of 3 groups. Physicians who were offered personal educational visits by clinical pharmacists along with a series of mailed unadvertisements reduced their prescribing of the target drugs by 14% as compared with controls (P = 0.0001). A comparable reduction in the number of dollars reimbursed for these drugs was seen between the 2 groups, resulting in substantial cost savings. No such change was seen in physicians who received mailed print materials only. The effect persisted for at least 9 mo. after the start of the intervention, and no significant increase in the use of expensive substitute drugs was found. Academically based detailing may represent a useful and cost-effective way to improve the quality of drug-therapy decisions and reduce unnecessary expenditures.