Journal of General Internal Medicine

, Volume 24, Issue 8, pp 897–903 | Cite as

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

  • Robert J. Fortuna
  • Fang Zhang
  • Dennis Ross-Degnan
  • Francis X. Campion
  • Jonathan A. Finkelstein
  • Jamie B. Kotch
  • Adrianne C. Feldstein
  • David H. Smith
  • Steven R. Simon
Original Article



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


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.


Cluster-randomized controlled trial.


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


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%).


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

Trial Registration Identifier: NCT00788346.


prescription drugs effectiveness marketed medications prescribing decision support computerized alerts 



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.

Supplementary material

11606_2009_1013_MOESM1_ESM.doc (286 kb)
ESM (DOC 285 Kb)


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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Robert J. Fortuna
    • 1
    • 2
  • Fang Zhang
    • 1
  • Dennis Ross-Degnan
    • 1
  • Francis X. Campion
    • 1
    • 3
  • Jonathan A. Finkelstein
    • 1
  • Jamie B. Kotch
    • 1
  • Adrianne C. Feldstein
    • 4
  • David H. Smith
    • 4
  • Steven R. Simon
    • 1
  1. 1.Department of Ambulatory Care and PreventionHarvard Medical School and Harvard Pilgrim Health CareBostonUSA
  2. 2.Departments of Internal Medicine and PediatricsUniversity of Rochester School of Medicine and DentistryRochesterUSA
  3. 3.Harvard Vanguard Medical AssociatesBostonMAUSA
  4. 4.Center for Health Research, Kaiser Permanente NorthwestPortlandUSA

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