Original Article

Journal of General Internal Medicine

, Volume 24, Issue 8, pp 897-903

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

  • Robert J. FortunaAffiliated withDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health CareDepartments of Internal Medicine and Pediatrics, University of Rochester School of Medicine and Dentistry Email author 
  • , Fang ZhangAffiliated withDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care
  • , Dennis Ross-DegnanAffiliated withDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care
  • , Francis X. CampionAffiliated withDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health CareHarvard Vanguard Medical Associates
  • , Jonathan A. FinkelsteinAffiliated withDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care
  • , Jamie B. KotchAffiliated withDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care
  • , Adrianne C. FeldsteinAffiliated withCenter for Health Research, Kaiser Permanente Northwest
  • , David H. SmithAffiliated withCenter for Health Research, Kaiser Permanente Northwest
  • , Steven R. SimonAffiliated withDepartment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care

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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.

KEY WORDS

prescription drugs effectiveness marketed medications prescribing decision support computerized alerts