Feedback and reminders

der, Trudy Weijden van; Wensing, Michel; Eccles, Martin; Grol, Richard

doi:10.1002/9781118525975.ch13

Cited by 6 publications

(6 citation statements)

References 41 publications

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“…For example, a systematic review of 18 studies addressing the effectiveness of the dissemination of educational materials on guideline implementation found overall modest (median effect = 8.1%, range = 3.6%–17.0%) but short‐term improvements . Audit and feedback interventions have also been demonstrated to change practitioner behavior (median effect = 7%, range = 1.3%–16.0%), although the effect of the intervention is dependent on the context . Therefore, the effect size for the NSPMP meperidine intervention, 10%, 12%, and 13.5%, respectively, for the three outcome measures, is noteworthy, especially given the low cost of the intervention and that the overall downward trend was sustained for 33 months.…”

Section: Discussionsupporting

confidence: 75%

“…The apparent success of the intervention is encouraging given that the evidence regarding the effectiveness of educational interventions on changing practitioner behavior is mixed and that the effect size for such interventions is modest. For example, a systematic review of 18 studies addressing the effectiveness of the dissemination of educational materials on guideline implementation found overall modest (median effect = 8.1%, range = 3.6%–17.0%) but short‐term improvements .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The effect of an educational intervention on meperidine use in Nova Scotia, Canada: a time series analysis

Fisher

Zhang

Sketris

et al. 2011

Pharmacoepidemiology and Drug

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Purpose-To evaluate the impact of a prescriber focused individual educational and auditfeedback intervention undertaken by the Nova Scotia Prescription Monitoring Program (NSPMP) in March/April 2007 to reduce meperidine use.Method-The NSPMP records all prescriptions for controlled substances dispensed in community pharmacies in Nova Scotia, Canada. Oral meperidine use from 1 July 2005 to 31 December 2009 was examined using NSPMP data. Monthly totals for the following were obtained: number of individual patients who filled at least one meperidine prescription, number of prescriptions, and number of tablets dispensed. Data were analyzed graphically to observe overall trends. The intervention effect was estimated on the logarithmic scale with autocorrelations over time modeled by an integrated autoregressive moving average model for each outcome measure. Results-An CIHR Author ManuscriptCIHR Author Manuscript CIHR Author Manuscript confidence interval [CI] = 5%-18%), prescriptions by 10% (p <0.001; 95%CI = 3%-17%), and tablets by 13.5% (p <0.001, 95%CI = 6%-29%) in the post-intervention period.Conclusion-Given the risks associated with meperidine, determining that this intervention successfully reduced meperidine use is encouraging. This study highlights the potential for using population data such as the NSPMP to evaluate the effectiveness of population-level interventions to improve medication use, including professional, organizational, financial, and regulatory initiatives.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

The effect of an educational intervention on meperidine use in Nova Scotia, Canada: a time series analysis

Fisher

Zhang

Sketris

et al. 2011

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

show abstract

“…This impact is in line with previous data about reminders during clinical encounters. 10 Receiving the genetics prompt without completing the questionnaire might have also encouraged some referrals on the basis of the fact that almost 40% of referrals through the non-BPA mechanism were placed the same day the BPA fired. Furthermore, completing the questionnaire might have educated some staff about current guidelines and limited their need to continue using the questionnaire to identify high-risk individuals.…”

Section: Discussionmentioning

confidence: 99%

“…These barriers are consistent with the literature assessing the relative effectiveness of automated clinical reminders. 10,13,14 Furthermore, following current guidelines for genetic assessment requires detailed clinical information that is not captured in discrete data fields in Epic. The need to capture that data through a questionnaire prevented us from deploying options that have been shown to improve uptake and reduce alert fatigue, for example, targeted use on the basis of EHR-generated information, simple action items, and diversity of fit in workflow.…”

Section: Discussionmentioning

confidence: 99%

“…Such reminders have been widely applied and found to increase the rate of a desired behavior by 5%-10%. 10 To increase genetic assessment among oncology patients, funding to support projects to enhance evidence-based medicine was used to develop a Best Practice Advisory (BPA) in the EHR, Epic, to pilot in oncology clinics using recognized implementation strategies.…”

Section: Introductionmentioning

confidence: 99%

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Can Automated Alerts in the Electronic Health Record Encourage Referrals for Genetic Counseling and Testing Among Patients at High Risk for Hereditary Cancer Syndromes?

Zorn

Simonson

Faulkner

et al. 2022

JCO Oncology Practice

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PURPOSE: Up to 10% of cancers may be associated with an inherited mutation that increases cancer risk. National guidelines emphasize referral for genetic counseling and testing for patients whose personal and/or family history increases their risk of having a hereditary cancer syndrome. METHODS: To increase appropriate referrals for cancer genetic counseling and testing, we piloted an automated alert known as a Best Practice Advisory (BPA) in the electronic health record, Epic, to notify oncology providers when a patient had a personal and/or family history that merited referral to cancer genetics. Epic could not gather the complex clinical data needed for the referral decision automatically, necessitating staff completion of a questionnaire. After educating providers, the BPA was implemented with resources to support its use. RESULTS: Initial interaction with the alert was high but rapidly dwindled, resulting in questionnaire completion in 7.2% of more than 32,000 encounters and 14.9% of patients over 9 months. However, cancer genetics referrals increased 95.9% during the pilot ( P < .0001), with 18.5% placed through the BPA and the rest from a non-BPA mechanism. Semistructured interviews with key stakeholders revealed not only general acceptance of the BPA concept but also barriers to completion, such as pressure to room patients quickly in the face of competing BPAs and lack of buy-in from some providers. CONCLUSION: These results suggest that provider engagement and BPA fatigue are significant obstacles to acceptance of a new automated alert. Despite interest in a tool for cancer genetics, the demand on clinical time for this complex BPA was poorly tolerated.

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Improving Sleep Quality Through Integrated Care

Renqvist

Bramoweth

2018

Behavioral Medicine and Integrated Care

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Feedback and reminders

Cited by 6 publications

References 41 publications

The effect of an educational intervention on meperidine use in Nova Scotia, Canada: a time series analysis

The effect of an educational intervention on meperidine use in Nova Scotia, Canada: a time series analysis

Can Automated Alerts in the Electronic Health Record Encourage Referrals for Genetic Counseling and Testing Among Patients at High Risk for Hereditary Cancer Syndromes?

Improving Sleep Quality Through Integrated Care

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