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Randomized Controlled Trial
. 2009 Aug;24(8):897-903.
doi: 10.1007/s11606-009-1013-x. Epub 2009 May 28.

Reducing the prescribing of heavily marketed medications: a randomized controlled trial

Robert J Fortuna  1 , Fang Zhang, Dennis Ross-Degnan, Francis X Campion, Jonathan A Finkelstein, Jamie B Kotch, Adrianne C Feldstein, David H Smith, Steven R Simon
Affiliations
Randomized Controlled Trial

Reducing the prescribing of heavily marketed medications: a randomized controlled trial

Robert J Fortuna et al. J Gen Intern Med. 2009 Aug.

Abstract

Context: Prescription drug costs are a major component of health care expenditures, yet resources to support evidence-based prescribing are not widely available.

Objective: To evaluate the effectiveness of computerized prescribing alerts, with or without physician-led group educational sessions, to reduce the prescribing of heavily marketed hypnotic medications.

Design: Cluster-randomized controlled trial.

Setting: We randomly allocated 14 internal medicine practice sites to receive usual care, computerized prescribing alerts alone, or alerts plus group educational sessions.

Measurements: Proportion of heavily marketed hypnotics prescribed before and after the implementation of computerized alerts and educational sessions.

Main results: The activation of computerized alerts held the prescribing of heavily marketed hypnotic medications at pre-intervention levels in both the alert-only group (adjusted risk ratio [RR] 0.97; 95% CI 0.82-1.14) and the alert-plus-education group (RR 0.98; 95% CI 0.83-1.17) while the usual-care group experienced an increase in prescribing (RR 1.31; 95% CI 1.08-1.60). Compared to the usual-care group, the relative risk of prescribing heavily marketed medications was less in both the alert-group (Ratio of risk ratios [RRR] 0.74; 95% CI 0.57-0.96) and the alert-plus-education group (RRR 0.74; 95% CI 0.58-0.97). The prescribing of heavily marketed medications was similar in the alert-group and alert-plus-education group (RRR 1.02; 95% CI 0.80-1.29). Most clinicians reported that the alerts provided useful prescribing information (88%) and did not interfere with daily workflow (70%).

Conclusions: Computerized decision support is an effective tool to reduce the prescribing of heavily marketed hypnotic medications in ambulatory care settings.

Trial registration: clinicaltrials.gov Identifier: NCT00788346.

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Figures

Figure 1
Figure 1
Study Flow Diagram * Clinicians did not receive prescribing alerts for refills for medications begun prior to the initiation of the study or if they joined HMVA after the initiation of the study † Analyses performed on group level data; Actual number of clinicians in each group may vary during the study period based on newly hired clinicians or clinicians leaving the practice.
Figure 2
Figure 2
a. Monthly Prescriptions for Heavily Marketed Hypnotic Medications. The figure shows the reduction of heavily marketed hypnotic medications attributable to the implementation of alerts (vertical lint) in both the alert-only and alert-plus-education groups. The initial increase in prescribing corresponds to the increasing availability of Ambien CR®, Lunesta®, and Rozerem® in mid-2005. b. After the implementation of alerts (vertical line), the proportion of heavily marketed hypnotics [study medications/study medications plus generic zolpidem and trazodone] remained stable in the alert-only and alert-plus-education groups while the proportion increased in the usual-care group.
See this image and copyright information in PMC

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