Improving Drug Prescribing in a Primary Care Practice

Gehlbach, Stephen H.; Wilkinson, William E.; Hammond, W. Ed; Clapp, N.E.; Finn, Arthur L.; Taylor, William J.; Rodell, Marjorie

doi:10.1097/00005650-198403000-00002

Cited by 102 publications

(33 citation statements)

References 20 publications

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“…Previous literature has supported the rationale that computerized, summative feedback will alter behavior (Gehlbach, Wilkinson, Hammond, Clapp, Finn, & Taylor et al, 1984). The findings of this investigation support these findings, but the hypothesis that both the perceived knowledge and likelihood to pursue CE would change together due to feedback were not supported by the results.…”

Section: Predictors Of Pursuing Continuing Education and Perceived Kncontrasting

confidence: 74%

Effect of Performance Feedback on Perceived Knowledge and Likelihood to Pursue Continuing Education

Eberman¹

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To all my family and friends, I am thankful for your patience and willingness to help, even when it seemed helpless. To my mother and father, thank you for instilling the need to learn and the desire to succeed. To Ryan, you remind me to be content with today, but give me hope for more tomorrow. To Blair, thank you for bringing out the child in me-we will always be young at heart if we have each other. To my running buddies Jenn and Pattie, thank you for helping me find a way to relieve the anxiety to this seemingly impossible obstacle. To all those that helped in my many times of need, you know who you are and I am indebted to you always. The purpose of this study was to assess the effect of performance feedback on Athletic Trainers' (ATs) perceived knowledge (PK) and likelihood to pursue continuing education (CE). The investigation was grounded in the theories of "the definition of the situation" (Thomas & Thomas, 1928) and the "illusion of knowing," (Glenberg, Wilkinson, & Epstein, 1982) suggesting that PK drives behavior. This investigation measured the degree to which knowledge gap predicted CE seeking behavior by providing performance feedback designed to change PK.A pre-test post-test control-group design was used to measure PK and likelihood to pursue CE before and after assessing actual knowledge. ATs (n=103) were randomly sampled and assigned to two groups, with and without performance feedback. Two independent samples t-tests were used to compare groups on the difference scores of the dependent variables. Likelihood to pursue CE was predicted by three variables using multiple linear regression: perceived knowledge, pre-test likelihood to pursue CE, and knowledge gap. In this investigation, performance feedback significantly increased participants' likelihood to pursue CE. Pre-test knowledge gap was a significant predictor of likelihood to pursue CE, regardless if performance feedback was provided. ATs may have selfassessed and engaged in internal feedback as a result of their test-taking experience.These findings indicate that feedback, both internal and external, may be necessary to trigger CE seeking behavior.

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Section: Predictors Of Pursuing Continuing Education and Perceived Kncontrasting

confidence: 74%

Effect of Performance Feedback on Perceived Knowledge and Likelihood to Pursue Continuing Education

Eberman¹

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“…The most promising method of improving prescribing practices of physicians in office-based practices has been the use of brief one-to-one educational outreach visits by either specially trained clinical pharmacists (Avorn & Soumerai 1983, 1986 or physician counsellors (Gehlbach et al 1984;Schaffner et al 1983). This method has been shown to substantially reduce inappropriate prescribing of contraindicated or expensive antibiotics, ineffective drugs for geriatric patients with peripheral vascular disease or senility, addictive analgesics and psychoactive drugs.…”

Section: Nonregulatory Methodsmentioning

confidence: 99%

Polypharmacy in the Aged

1994

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Elderly patients use more medications than younger patients and the trend of increasing drug use continues through 80 years of age. Studies conducted in a variety of settings have shown that patients over 65 years of age use an average of 2 to 6 prescribed medications and 1 to 3.4 non-prescribed medications. Success of pharmaceutical and medical research has resulted in an abundance of effective drugs to treat acute and chronic conditions. Most research resulting in the development and marketing of these medications has been directed at proving the efficacy and safety of single drug products. Little research has been directed to determine the safety and efficacy of combining multiple medications to treat concurrent conditions in a single patient. It is known that the use of multiple medications increases the risks of adverse drug reactions, drug-drug interactions, and makes compliance with medication regimens more difficult. Numerous studies have been conducted to better understand factors that are associated with increased drug use in elderly people. Studies also have been conducted to identify interventions that can improve drug treatment for the elderly, and reduce polypharmacy. Multiple drug use is common in older people, and may give rise to drug related problems. Methods to reduce the risks of polypharmacy include patient education, physician education, such as education and feedback systems, and regulatory intervention. Continual drug and disease monitoring is essential.

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“…Because the paper record does not routinely provide a timely display of aggregated data as a disease management view, it does not facilitate the time needed to adequately document the encounter, assess the status of the patient, and plan appropriate counseling, testing, and referrals. Because of this problem, a variety of strategies, such as flow sheets, reminder cards, and patient record books, have been used to supplement the paper record, facilitate the recognition of key clinical data, and prompt the provider (and patient) to comply with standards of care (5)(6)(7)(8)(9)(10)(11).…”

mentioning

confidence: 99%