Study details country/setting | Populations | Intervention | Control |
---|---|---|---|
Cluster RCT | |||
Braybrook and Walker17 UK/primary care | General medical practices contracted to Gwent Health Authority (September 1993–March 2004) | Active feedback (N=34 practices): visits from pharmaceutical prescribing adviser to present prescribing analysis and cost (PACT) data concerning NSAID use and to promote prescribing review | Passive feedback (N=32 practices): practice specific prescribing analysis workbook containing similar information to the intervention Reference group (N=22 practices): received no information on NSAIDs from the prescribing adviser |
RCT | |||
Meyer et al16 South Africa/primary healthcare clinics | Primary healthcare nurses in the Northern Province of South Africa (1997) | Four-day effective prescribing training workshops provided by 24 provincial trainers who had previously received a generic training-of-trainers course and a 1-week effective prescribing course. The effective prescribing training used the WHO annual Guide to good prescribing as a framework and problem-based learning methods were used. N=12 primary healthcare clinics randomised (11 analysed) | No training N=12 primary healthcare clinics randomised (11 analysed) |
CBA | |||
Fischer et al20 USA/community-based practices | Clinicians from community-based practices from Massachusetts (2003–2005) | E-prescription with FDS); e-prescription system (pocket script) identifies preferred medications, often generic medications N=1198 clinicians (clinicians needed to write at least 1 e-priscriptions) | Unenrolled prescribers (clinicians who did not use e-prescription) N=34 453 clinicians |
Geoghegan et al21 UK/primary care | General practices in St Helens and Knowsley | Prescribing meetings (at least six meetings a year) held between local GPs and community pharmacists, with the agenda determined by GPs and pharmacists N=8 practices | Practices not participating in meetings N=50 practices |
Leach and Wakeman22 UK/primary care | Pharmacists and GP (general practitioners) practices in Dudley health authority | Prescribing advice to local GP from community pharmacists who had received relevant additional training (each practice received four visits a year from their community pharmacist) N=5 practices (11 partners) | All remaining GP practices from the same health authority N=58 practices (151 partners) |
Mastura and Teng19 Malaysia/health clinic | Medical officers from government health clinics in Negeri Sembilan (2004) | Group academic detailing N=5 medical officers (1 clinic, 1848 prescriptions) | No intervention N=4 medical officers (1 clinic, 1525 prescriptions) |
Niquille et al26 Switzerland/primary care | General practices in the Swiss Canton of Fribourg who were non-dispensing physicians (1999–2007) | Quality circles (N=6 circles; 6 pharmacists and 24 GPs) Groups were moderated by specifically trained pharmacists (intervention included networking, feedback, interdisciplinary continuing education) | No intervention (N=79 to 753 GPs each year since 1999) |
Onion and Dutton23 UK/primary care | General practitioners (GP) in the Wirral Health Authority (1992–1993) | N=10 practices Based on Ford's motivational systems theory Included financial incentive; standard setting for improvement; interactive education; agreed performance standards for cost savings and clinical audit | No intervention (N=10 practices) |
Walker and Mathers4 UK/primary care | General practitioners involved in a commissioning group pilot in Southern Derbyshire (1997–1999) | N=9 practices; 36 GPs Pharmaceutical adviser 1 day/week for a year. Intervention included practice comparison feedback, peer review meetings and prescribing recommendations | No intervention (N=9 practices; 44 GPs) |
Wensing et al25 Germany/primary care | Primary care doctors from the Sachsen-Anhalt region, mainly from single-handed practices (1996–1998) | Quality circles (N=10 circles; 90 GPs) Groups were moderated by specifically trained primary care physicians. Intervention included educational session and structured feedback on individual prescribing practices | No intervention (N=87 GPs): random sample of physicians in the same region |
Wensing et al18 Germany/primary care | Primary care physicians (GPs) from three regions (2001–2003) | Quality circles (N=152 circles; 1090 GPs) Nine meetings. Intervention included provision of evidence-based information and repeated feedback on individual prescribing patterns) | No intervention (N=2090 GPs): random sample of physicians in the same region |
ITS | |||
Lopez-Picazo (2002)28 Spain/primary care | Primary care teams from four of the six health areas of Murcia (1998–2000) | N=45 practices; 339 GPs Each individual received information about the individual, team and health district prescribing behaviour; regularly updated information on generic drugs; up to three clinical outreach sessions with each primary care team; and specific generic prescribing goals and financial incentives to achieve the goals. | N A |
Stenner et al27 USA/Vanderbilt Medical Group's outpatient clinics | Healthcare practitioners at a single medical centre, VUMC (2005–2008) | E prescribing system (Rx-Star) Changes were made to how medications were displayed on the current e-prescribing system; available generic formulations were displayed in a larger bolder font and were listed above brand name medications regardless of whether the practitioner searched for generic or brand name N=1.1 million electronic prescriptions from 2000 unique prescribers | Handwritten prescriptions that were filled at a single VUMC outpatient pharmacy (without e-prescribing, non-Rx-Star) N=4456 randomly sampled prescriptions |
N A, not applicable.