Reducing the Prescribing of Heavily Marketed Medications: A Randomized Controlled Trial

Fortuna, Robert J.; Zhang, Fang; Ross‐Degnan, Dennis; Campion, Francis X.; Finkelstein, Jonathan A.; Kotch, Jamie B.; Feldstein, Adrianne C.; Smith, David H.; Simon, Steven R.

doi:10.1007/s11606-009-1013-x

Cited by 21 publications

(35 citation statements)

References 29 publications

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“…As presented in Additional file 2, Table S2, the majority of CCDSS systems in our sample were integrated with an EMR (n = 38/61, 62%) [17,18,20,23-26,28,31,32,34,40,42,44-47,49,55,56,58-66,68-70,73,74,77-85,87,89], delivered feedback via a computer display (n = 44/62, 71%) [17,18,20,23-26,28,30-36,38-40,42,44,46-49,51,55-58,60-66,68-71,73-76,80,82-84] at the time of care (n = 53/64, 83%) [16-21,23-26,28,30-35,38,40,42,44,46-51,53,55-58,60-70,72-85,87-89]. A minority of authors reported testing a CCDSS with a graphical user interface (n = 22/25, 88%) [16-18,20,21,23-25,28,30,31,34,38,40,45,46,55,56,58-60,…”

Section: Resultsmentioning

confidence: 99%

“…A minority of authors reported testing a CCDSS with a graphical user interface (n = 22/25, 88%) [16-18,20,21,23-25,28,30,31,34,38,40,45,46,55,56,58-60,63,65,70,73,75,83], pilot-testing the system before the trial (n = 25/45, 56%) [17-19,24,28,29,31-33,35,38,39,43-45,47,48,55,59,63,66,70-72,74,75,77-79,84], or training users on system use (n = 29/52, 56%) [16,19,21,26,28,29,31,32,34,35,38,43-47,53,56-60,62,64-66,69,75-79,83-85]. Data required by the CCDSS to produce recommendations were most commonly entered via EMR link (n = 32/61, 52%) [17,18,20,24,26,28,31,32,34,40,44-47,49,51,55,56,58-60,62-66,68-…”

Section: Resultsmentioning

confidence: 99%

“…Data required by the CCDSS to produce recommendations were most commonly entered via EMR link (n = 32/61, 52%) [17,18,20,24,26,28,31,32,34,40,44-47,49,51,55,56,58-60,62-66,68-70,74,80-82,84,85,87,89], followed by provider entry (n = 23/61, 38%) [16,21,23,25,30,31,34,35,38,39,46,53,56,63,64,66,67,69-71,73,75,76,80,83,86,88], study staff (n = 10/61, 16%) [19,39,42,43,48,61,63,70,74,86,89], and existing staff (n = 8/61, 13%) [36,37,68,72-74,88,89], although multiple modes of entry were reported in some studies. Nineteen (29%) [17,18,20,23-25,31,32,34,35,42,45-47,56,58-60,80,82-84] studies reported using systems that were integrated with CPOE.…”

Section: Resultsmentioning

confidence: 99%

“…No significant difference was found between Rx-only (23/33) [18,22,23,26,30,32,33,35-38,41,43,48,50,54,58,62,65,68,73,81,87,89] and multi-faceted (14/26) [16,19,21,27,29,31,40,45,52,53,57,59,63,70,74,75,80] CCDSSs for process of care improvement.…”

Section: Resultsmentioning

confidence: 99%

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Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review

et al. 2011

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BackgroundComputerized clinical decision support systems (CCDSSs) for drug therapy management are designed to promote safe and effective medication use. Evidence documenting the effectiveness of CCDSSs for improving drug therapy is necessary for informed adoption decisions. The objective of this review was to systematically review randomized controlled trials assessing the effects of CCDSSs for drug therapy management on process of care and patient outcomes. We also sought to identify system and study characteristics that predicted benefit.MethodsWe conducted a decision-maker-researcher partnership systematic review. We updated our earlier reviews (1998, 2005) by searching MEDLINE, EMBASE, EBM Reviews, Inspec, and other databases, and consulting reference lists through January 2010. Authors of 82% of included studies confirmed or supplemented extracted data. We included only randomized controlled trials that evaluated the effect on process of care or patient outcomes of a CCDSS for drug therapy management compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive.ResultsSixty-five studies met our inclusion criteria, including 41 new studies since our previous review. Methodological quality was generally high and unchanged with time. CCDSSs improved process of care performance in 37 of the 59 studies assessing this type of outcome (64%, 57% of all studies). Twenty-nine trials assessed patient outcomes, of which six trials (21%, 9% of all trials) reported improvements.ConclusionsCCDSSs inconsistently improved process of care measures and seldomly improved patient outcomes. Lack of clear patient benefit and lack of data on harms and costs preclude a recommendation to adopt CCDSSs for drug therapy management.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review

et al. 2011

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“…There are many published studies on prescribing alerts. These include reports of alert's effectiveness in reducing inappropriate medications for elderly patients in the emergency department and other settings,[ 11 12 13 ] reducing prescribing of heavily marketed hypnotic medications in ambulatory care settings,[ 14 ] and reducing overall prescribing of antimicrobials in addition to improving the appropriateness of antimicrobial prescribing. [ 15 16 17 ] According to a review of the literature on prescribing alerts in the elderly, a wide variety of CPOE interventions show clear potential to reduce inappropriate prescribing and polypharmacy in this population, but none of these have yet been widely adopted.…”

Section: Discussionmentioning

confidence: 99%

Can automated alerts within computerized physician order entry improve compliance with laboratory practice guidelines for ordering Pap tests?

Howell¹,

MacDonald²,

Jones³

et al. 2014

Journal of Pathology Informatics

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Background:The electronic health record (EHR) provides opportunity to improve health and enhance appropriate test utilization through decision support. Electronic alerts in the order entry system can guide test use. Few published reports have assessed the impact of automated alerts on compliance of Pap ordering with published screening guidelines.Methods:Programming rules for Pap test ordering were developed within the EHR (Epic, Madison, WI) of the University of California, Davis Health System using American College of Obstetrics and Gynecology's 2009 guidelines and implemented in primary care clinics in 2010. Alerts discouraged Pap orders in women <21 and >71 years and displayed when an order was initiated. Providers were not prevented from placing an order. Results were measured during four calendar periods: (1) pre-alert (baseline) (July 2010 to June 2011), (2) post alert (alerts on) (July 2011 to December 2011), (3) inadvertent alert turn-off (“glitch”) (January 2012 to December 2012), (5) post-glitch (alerts re-instated) (1/2013-7/2013). Metrics used to measure alert impact were between time and period seasonally adjusted relative frequency ratios.Results:Alerts were most effective in the <21 year old age group. During the baseline period 2.7 Pap tests were order in patients less than age 21 for every 100 Paps in those 21-71 years of age. This relative frequency decreased to 1.7 in the post-alert period and 1.4 during the glitch, with an even greater decline to 0.8 post-glitch when alerts were reinstated. Less impact was observed in the >70 year old group where the baseline relative frequency was 2.4 and declined to 2.1 post-alert, remained stable at 2.0 during the glitch period, and declined again to 1.7 post-glitch when alerts were reinstated. This likely reflects inclusion of women with a history of abnormal Pap tests for whom continued Pap testing is indicated, as well as reluctance by providers and patients to accept discontinuation of Pap testing for women with a history of normal Pap results. In both age groups, decreases in ordering were greatest when the alerts were functioning, indicating that the alerts had an effect beyond the influences of the environment.Conclusions:Discouraging alerts can impact ordering of Pap tests and improve compliance with established guidelines, thus avoiding unnecessary follow-up tests that can create potential patient harm and unnecessary expense. Alerts represent a potential model to address utilization of other lab tests. Longer study intervals are necessary to determine if provider compliance is maintained.

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Training Physicians to Provide High-Value, Cost-Conscious Care

Stammen

Stalmeijer

Paternotte

et al. 2015

JAMA

172

154

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Reducing the Prescribing of Heavily Marketed Medications: A Randomized Controlled Trial

Abstract: clinicaltrials.gov Identifier: NCT00788346.

Cited by 21 publications

References 29 publications

Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review

Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review

Can automated alerts within computerized physician order entry improve compliance with laboratory practice guidelines for ordering Pap tests?

Training Physicians to Provide High-Value, Cost-Conscious Care

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