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

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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.

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Acknowledgements

This work was supported by a grant from the State Attorney General Consumer and Prescriber Education Grant Program, which is funded through the multi-state settlement from the unlawful marketing of the prescription drug Neurontin®. Dr. Fortuna was supported by an Institutional National Research Service Award, #5 T32 HP11001–18.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA

    Robert J. Fortuna MD, MPH, Fang Zhang PhD, Dennis Ross-Degnan ScD, Francis X. Campion MD, Jonathan A. Finkelstein MD, MPH, Jamie B. Kotch SM & Steven R. Simon MD, MPH

  2. Departments of Internal Medicine and Pediatrics, University of Rochester School of Medicine and Dentistry, 913 Culver Road, Rochester, NY, 14609, USA

    Robert J. Fortuna MD, MPH

  3. Harvard Vanguard Medical Associates, Boston, MA, USA

    Francis X. Campion MD

  4. Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA

    Adrianne C. Feldstein MD & David H. Smith PhD

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  1. Robert J. Fortuna MD, MPH
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Correspondence to Robert J. Fortuna MD, MPH.

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Fortuna, R.J., Zhang, F., Ross-Degnan, D. et al. Reducing the Prescribing of Heavily Marketed Medications: A Randomized Controlled Trial. J GEN INTERN MED 24, 897–903 (2009). https://doi.org/10.1007/s11606-009-1013-x

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  • DOI: https://doi.org/10.1007/s11606-009-1013-x

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