Pharmacy World and Science

, Volume 21, Issue 4, pp 158–167 | Cite as

Changing doctor prescribing behaviour

  • P.S. Gill
  • M. Mäkelä
  • K.M. Vermeulen
  • N. Freemantle
  • G. Ryan
  • C. Bond
  • T. Thorsen
  • F.M. Haaijer‐Ruskamp


The aim of this overview was to identify interventions that change doctor prescribing behaviour and to derive conclusions for practice and further research. Relevant studies (indicating prescribing as a behaviour change) were located from a database of studies maintained by the Cochrane Collaboration on Effective Professional Practice. This register is kept up to date by searching the following databases for reports of relevant research: DHSS‐DATA; EMBASE; MEDLINE; SIGLE; Resource Database in Continuing Medical Education (1975‐1994), along with bibliographies of related topics, hand searching of key journals and personal contact with content area experts. Randomised controlled trials and non‐equivalent group designs with pre‐ and post‐intervention measures were included. Outcome measures were those used by the study authors. For each study we determined whether these were positive, negative or inconclusive. Positive studies (+) were those that demonstrated a statistically significant change in the majority of outcomes measured at level of p ≤0.05 between the intervention and control groups. Negative studies (‐) showed a significant change in the opposite direction and inconclusive studies (≈) showed no significant change compared to control or no overall positive findings. We identified 79eligible studies which described 96 separate interventions to change prescribing behaviour. Of these interventions, 49 (51%, 41%‐61%) showed a positive significant change compared to the control group but interpretation of specific interventions is limited due to wide and overlapping confidence intervals.

Control Groups Intervals Interventions 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    OECD Health Data 96. A software for the comparative analysis of 27 health systems. CREDES: OECD, 1996.Google Scholar
  2. 2.
    Audit Commission. A Prescription for Improvement. Towards more Rational prescribing in General Practice. London: HMSO, 1994.Google Scholar
  3. 3.
    Bloor K, Freemantle N. Lessons from international experience in controlling pharmaceutical expenditure II: Influencing doctors. BMJ 1996;312:1525-7.PubMedGoogle Scholar
  4. 4.
    Soumerai SB Avorn J. Efficacy and Cost-containment in Hospital Pharmacotherapy: State of the Art and Future Directions. Milbank Memorial Fund Quarterly/Health and Society 1984;62:447-74.Google Scholar
  5. 5.
    Soumerai SB, McLaughlin TJ, Avorn J. Improving Drug Prescribing in Primary Care: A Critical Analysis of the Experimental Literature. Milbank Quarterly 1989;67:268-317.PubMedGoogle Scholar
  6. 6.
    Davis DA, Thomson MA, Oxman AD, Haynes RB. Evidence for the Effectiveness of CME: a review of 50 randomised controlled trials. JAMA 1992;268:1111-7.PubMedGoogle Scholar
  7. 7.
    Oxman AD, Thomson MA, Davis DA, Haynes RB. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. Can Med Assoc J 1995;153:1423-31.Google Scholar
  8. 8.
    Effective Health Care Bulletin (1994). Implementing Clinical Practice Guidelines. Bulletin No 8. Leeds: University of Leeds.Google Scholar
  9. 9.
    Bero L, Grilli R, Grimshaw J, Oxman AD (eds). In: Cochrane Collaboration on Effective Professional Practice (CCEPP) Module of The Cochrane Database of Systematic Reviews, [updated 02 December 1996]. Available on The Cochrane Library [database on disc and CDROM]. The Cochrane Collaboration; Issue 1. Oxford: Update Software; 1997. Updated quarterly.Google Scholar
  10. 10.
    Cook TD, Campbell DT. Quasi-experimentation: design and analysis issues for field settings. Chicago: Rand McNally, 1979.Google Scholar
  11. 11.
    Hedges LV, Olkin I. tatistical methods for meta analysis. London: Academic Press, 1985.Google Scholar
  12. 12.
    Avorn J, Soumerai SB, Taylor W, et al. Reduction of incorrect antibiotic dosing through a structured educational order form. Arch Intern Med 1988;148:1720-4.PubMedGoogle Scholar
  13. 13.
    Berbatis CG, Maher MJ, Plumridge RJ, Stoelwinder JU, Zubrick SR. Impact of a drug bulletin on prescribing oral analgesics in a teaching hospital. Am J Hosp Pharm 1982;39:98-100.PubMedGoogle Scholar
  14. 14.
    Bottiger LE, Westerholm B. Drug-induced blood dyscrasias in Sweden BMJ 1973;3:339-43.PubMedGoogle Scholar
  15. 15.
    Evans RS, Classen DC, Pestotnik SL, Lundsgaarde, Burke JP. Improving empiric antibiotic selection using computer decision support. Arch Intern Med 1994; 154: 878-84.PubMedGoogle Scholar
  16. 16.
    Everitt DE, Soumerai SB, Avorn J, Klapholz H, Wessels M. Changing surgical antimicrobial prophylaxis practices through education targeted at senior department leaders. Infect Control Hosp Epidemiology 1990; 11(11): 578-83Google Scholar
  17. 17.
    Gurwitz JH, Noonan JP, Soumerai SB. Reducing the use of H2-receptor antagonists in the long-term-care setting. J Am Geriatr Soc 1992;40(4):359-64.PubMedGoogle Scholar
  18. 18.
    Ross-Degnan D, Soumerai SB, Fortess EE, Gurwitz JH. Examining product risk in context: market withdrawal of Zomepirac as a case study. JAMA 1993;270(16):1937-42.PubMedGoogle Scholar
  19. 19.
    Soumerai SB, Avorn J, Gortmaker S and Hawley S. Effect of government and commercial warnings on reducing prescription misuse: the case of propoxyphene. Am J Public Health. 1987;77:1518-23.PubMedGoogle Scholar
  20. 20.
    Soumerai SB, McLaughlin TJ, Ross-Degnan D, Casteris CS, Bollini P. Effects of limiting Medicaid drug-reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia. N Eng J Med 1994;331:650-5.Google Scholar
  21. 21.
    Soumerai SB, Avorn J, Taylor WC, Wessels M, Maher D, Hawley SL. Improving choice of prescribed antibiotics through concurrent reminders in an educational order form. Med Care 1993;31(6):552-8.PubMedGoogle Scholar
  22. 22.
    Bass MJ, McWhinney IR, Donner A. Do family physicians need medical assistants to detect and manage hypertension? Can Med Assoc J 1986;134:1247-55.Google Scholar
  23. 23.
    Brown LF, Keily PA, Spencer AJ. Evaluation of a continuing medical education intervention 'periodontics in general practice. Community Dent Oral Epidemiol 1994;22:441-7.PubMedGoogle Scholar
  24. 24.
    Cohen DI, Littenberg B, Wetzel C, Neuhaser DvB. Improving physician compliance with preventive medicine guidelines. Med Care 1982;XX:1040-5.Google Scholar
  25. 25.
    Dickinson GR, Holzemer WL, Nichols E. Evaluation of an arthritis continuing education program. The Journal of Continuing Education in Nursing 1985;16(4):127-31.Google Scholar
  26. 26.
    Epstein LM, Avni A, Hopp C, Flug D. Evaluation of a program of aftercare for patients discharged from the hospital. Med Care 1973;114):320-7.PubMedGoogle Scholar
  27. 27.
    Fabacher D, Josephson K, Pietruszka F, Linderborn K, Morley JE, Rubenstein LZ. An in-home preventive assessment program for independent older adults: a randomized controlled trial. J Am Geriatr Soc 1994;42:630-8.PubMedGoogle Scholar
  28. 28.
    Greenfield S, Friedland G, Scifers S, Rhodes A, Black WL, Komaroff AL. Protocol management of dysuria, urinary frequency, and vaginal discharge. J Fam Practice 1975; 2(3):179-84.Google Scholar
  29. 29.
    Harris BL, Stergachis A, Ried LD. The effect of drug co-payments on utilization and cost of pharmaceuticals in a health maintenance organization. Med Care 1990;28(10):907-17.PubMedGoogle Scholar
  30. 30.
    Hastings JEF, Mott FD, Barclay A, Hewitt D. Prepaid group practice in Sault Ste. Marie, Ontario: Part I: analysis of utilization records, Med Care 1973;11(2):91-103.PubMedGoogle Scholar
  31. 31.
    Hedrick SC, Rothman ML, Chapko M, Inui TS, Kelly JR, Ehreth J. Overview and patient recruitment in the adult day health centre evaluation study. Med Care 1993;31(9 suppl): SS3-SS14.PubMedGoogle Scholar
  32. 32.
    Hodnett E, Kaufman K, O'Brien-Pallas L, Chipman M. A Strategy to Promote Research-Based Nursing Care: Effects on Childbirth Outcomes. Final Report of Project No.6606-4076-57E funded by the National Health Research and Development Program, Health Canada. 31 March 1994.Google Scholar
  33. 33.
    Inui TS. Yourtee EL and Williamson JW. Improved outcomes in hypertension after physician tutorials: a controlled trial. Ann Intern Med 1976; 84: 646-51.PubMedGoogle Scholar
  34. 34.
    Jin BW, Kim SC, Mori T, Shimao T. The impact of intensified supervisory activities on tuberculosis treatment. Tubercle and Lung Disease 1993; 74(4): 267-72.PubMedGoogle Scholar
  35. 35.
    Katon W, von Korff M, Lin E, Bush T, Ormel J. Adequacy and duration of antidepressant treatment in primary care. Med Care 1992;30(1):67-76.PubMedGoogle Scholar
  36. 36.
    Kimberlin CL, Berardo DH, Pendergast JF, McKenzie LC. Effects of an education program for community pharmacists on detecting drug-related problems in elderly patients. Med Care 1993;31(5):451-68.PubMedGoogle Scholar
  37. 37.
    Kozma CM, Reeder CE, Lingle EW. Expanding Medicaid drug formulary coverage: effects on utilization of relates services. Med Care 1990;28(10):963-77.PubMedGoogle Scholar
  38. 38.
    Krasnik A, Groenewegen PP, Pedersen PA, von Scholten P, Mooney G, Gottschau A, Flierman HA, Damsgaard MT. Changing remuneration systems: effects on activity in general practice. BMJ 1990;300:1698-701.PubMedGoogle Scholar
  39. 39.
    Logan AG, Milne BJ, Achber C, Campbell WP, Haynes RB. Cost-effectiveness of a worksite hypertension treatment program. Hypertension 1981;3(2):211-8.PubMedGoogle Scholar
  40. 40.
    Mackie IC, Worthington HV, Hobson P. An investigation into sugar-containing and sugar-free over-the-counter medicines stocked and recommended by pharmacists in the North Western Region of England. Brit Dent J 1993; 175(93): 93-8.PubMedGoogle Scholar
  41. 41.
    Melin AL, Bygren LO. Efficacy of the rehabilitation of elderly primary health care patients after short-stay hospital treatment. Med Care 1992;30(11):1004-15.PubMedGoogle Scholar
  42. 42.
    Naughton BJ, Moran MB, Feinglass J, Falconer J, Williams ME. Reducing hospital costs for the geriatric patient admitted from the emergency department: a randomized trial. JAGS 1994;42:1045-9.Google Scholar
  43. 43.
    Perera DR, LoGerfo JP, Shulenberger E, Ylvisaker JT, Kirz HL. Teaching sigmoidoscopy to primary care physicians: a controlled study of continuing medical education. J Fam Pract 1983;16(4):785-8.PubMedGoogle Scholar
  44. 44.
    Peterson AM, Kirkwood CF, Hansen LA. nfluence of a decision analysis model on selection of drug therapy. Am J Hosp Pharm 1991;48:1477-83.PubMedGoogle Scholar
  45. 45.
    Rogers JL, Haring OM. The impact of a computerized medical record summary system on incidence and length of hospitalization. Med Care 1979;17:618-30.PubMedGoogle Scholar
  46. 46.
    Sanazaro PJ, Worth RM. Concurrent quality assurance in hospital care. Report of a study by private initiative in PSRO. N Eng J Med 1978;298(21):1171-7.Google Scholar
  47. 47.
    Simmer TL, Nerenz DR, Rutt WM, Newcomb CS, Benfer DW. A randomized, controlled trial of an attending staff service in general internal medicine. Med Care 1991;29(7 suppl):JS31-40.PubMedGoogle Scholar
  48. 48.
    Simon JL, Barton Smith D. Change in location of a student health service: a quasi-experimental evaluation of the effects of distance on utilization. Med Care 1973;xi(1):59-67.Google Scholar
  49. 49.
    Sloan GA, Gordon GS, Cocks, DL. Hospital drug formularies and use of hospital services. Med Care 1993;31(10):851-67.PubMedGoogle Scholar
  50. 50.
    Smalley WE, Griffin MR, Fought RL, Sullivan L, Ray WA. Effect of a prior-authorization requirement on the use of nonsteroidal anti-inflammatory drugs by Medicaid patients. New Eng J Med 1995;332(24):1612-7.PubMedGoogle Scholar
  51. 51.
    Soumerai SB, Avorn J, Ross-Degnan D, Gortmaker S. Payment restrictions for prescription drugs under Medicaid. New Eng J Med 1987;317:550-6.PubMedGoogle Scholar
  52. 52.
    Soumerai SB, Ross-Degnan D, Avorn J, McLaughlin TJ, Choodnovskiy I. Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes. New Eng J Med 1991;325(15):1072-7.PubMedGoogle Scholar
  53. 53.
    Soumerai SB, Ross-Degnan D, Gortmaker S, Avorn J. Withdrawing payment for nonscientific drug therapy. AMA 1990;263(6):831-9.Google Scholar
  54. 54.
    The SUPPORT Principal Investigators. A Controlled Trial to Improve Care for Seriously Ill Hospitalized Patients. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). JAMA 1995;274(20):1591-98.Google Scholar
  55. 55.
    Thompson JF, McGhan WF, Ruffalo RL, Cohen DA, Adamcik B, Segal JL. Clinical Pharmacists Prescribing Drug Therapy in a Geriatric Setting: Outcome of a trial. J Am Geriatr Soc 1984;32(2):154-9.PubMedGoogle Scholar
  56. 56.
    Wing DS, Duff HJ. Evaluation of a therapeutic drug monitoring program for theophylline in a teaching hospital. Drug Intelligence and Clinical Pharmacy 1987;21:702-5.Google Scholar
  57. 57.
    Brady WJ, Hissa DC, McConnell M, Wones RG. Should physicians perform their own quality assurance audits? J Gen Intern Med 1988;3:560-65.PubMedGoogle Scholar
  58. 58.
    Cohen SJ, Christen AG, Katz BP, Drook CA, Davis BJ, Smith DM, Stookey GK. Counselling medical and dental patients about cigarette smoking: the impact of nicotine gum and chart reminders. Am J Public Health 1987;77:313-6.PubMedGoogle Scholar
  59. 59.
    De Santis G, Harvey KJ, Howard D, Mashford ML, Moulds RFW. Improving the quality of antiobiotic prescription patterns in general practice. Med J Australia 1994;160:502-5.PubMedGoogle Scholar
  60. 60.
    Evans CE, Haynes RB, Birkett NJ, Gilbert JR, Taylor DW, Sackett DL, Johnston ME, Hewson SA. Does a mailed continuing education program improve physician performance? Results of a randomized trial in antihypertensive care. JAMA 1986;255(4):501-4.PubMedGoogle Scholar
  61. 61.
    Herman CJ, Speroff T, Cebul RD. Improving compliance with immunization in the older adult: results of a randomized cohort study. JAGS 1994;42:1154-9.Google Scholar
  62. 62.
    Kendrick T, Burns T, Freeling P. Randomized controlled trial of teaching general practitioners to carry out structured assessments of their long term mentally ill patients. BMJ 1995;311:93-8.PubMedGoogle Scholar
  63. 63.
    Mazzuca SA, Vinicor F, Einterz RM, Tierney WM, Norton JA, Kalasinski LS. Effects of the clinical environment on physicians' response to postgraduate medical education. Am Educ Res J 1990;27(3):473-88.Google Scholar
  64. 64.
    Pinkerton RE, Tinanoff N, Willms JL, Tapp JT. Resident physician performance in a continuing education format: does newly acquired information improve patient care? JAMA 1980;244(19):2183-5.PubMedGoogle Scholar
  65. 65.
    Szczepura A, Wilmot J, Davies C, Fletcher J. Effectiveness and cost of different strategies for information feedback in general practice. Brit J Gen Pract 1994;44:19-24.Google Scholar
  66. 66.
    Tape TG, Givner N, Wigton RS, Seelig CB, Patil K, Campbell JR. Process in ambulatory care: a controlled clinical trial of computerized records. SCAMC 1988;749-52.Google Scholar
  67. 67.
    Turner RC, Peden JG, O'Brien K. Patient-carried card prompts vs computer-generated prompts to remind private practice physicians to perform health maintenance measures. Arch Int Med 1994;154:1957-60.Google Scholar
  68. 68.
    Turner RC, Waivers LE, O'Brien K. The effect of patient-carried reminder cards on the performance of health maintenance measures. Arch Intern Med 1990;150:645-7.PubMedGoogle Scholar
  69. 69.
    Wing D, Duff HJ. Impact of a therapeutic drug monitoring program for digoxin. Arch Intern Med 1987;147(8):1405-8.PubMedGoogle Scholar
  70. 70.
    Diwan VK, Wahlström R, Tomson G, Beermann B, Sterky G, Eriksson B. Effects of “group detailing” on the prescribing of lipid-lowering drugs: a randomized controlled trial in Swedish Primary Care. J Clin Epidemiol 1995;48:705-11.PubMedGoogle Scholar
  71. 71.
    North of England Study of Standards and Performance in General Practice. Medical audit in general practice: effects on doctors' clinical behaviour and the health of patients with common childhood conditions. BMJ 1992;304:1480-8.Google Scholar
  72. 72.
    Rokstad K, Straand J, Fugelli P. Can drug treatment be improved by feedback on prescribing profiles combined with therapeutic recommendations? A prospective controlled trial in general practice. J Clin Epidemiol 1995;48(8):1061-8.PubMedGoogle Scholar
  73. 73.
    Schaffner W, Ray WA, Federspiel CF, O'Miller WO. Improving antibiotic practice in office prescribing: a controlled trial of three educational methods. JAMA 1983;250:1728-32.PubMedGoogle Scholar
  74. 74.
    Stross JK, Bole GG. Evaluation of a continuing education program in rheumatoid arthritis. Arthritis Rheumatism 1980;23:846-9.PubMedGoogle Scholar
  75. 75.
    Stross JK, Bole GG. Evaluation of an educational program for primary care practitioners on the management of osteoarthritis. Arthritis Rheumatism 1985;28:108-11.PubMedGoogle Scholar
  76. 76.
    Stross JK, Hiss RG, Watts CM, Davis WK, MacDonald R. Continuing education in pulmonary disease for primary care physicians. Am Rev Resp Dis 1983;27:739-46.Google Scholar
  77. 77.
    Hawkins DW. Clinical pharmacy functions in ambulatory patient care. J Clin Pharmacol 1981;21(5-6):245-50.PubMedGoogle Scholar
  78. 78.
    Hershey CO, Goldberg HI, Cohen DI. The effect of computerized feedback coupled with a newsletter upon outpatient prescribing charges. Med Care 1988;26(1):88-93.PubMedGoogle Scholar
  79. 79.
    Schectman JM, Kanwal NJ, Schroth WS, Elinsky EG. The effect of an education and feedback intervention on groupmodel and network model health maintenance organization physician prescribing behavior. Med Care 1995;33:139-44.PubMedGoogle Scholar
  80. 80.
    Johnson RE, Campbell WH, Azevedo DJ, Christensen DB. Studying the impact of patient drug profiles in an HMO. Med Care 1976;14(10):799-807.PubMedGoogle Scholar
  81. 81.
    Hershey CO, Porter DK, Breslau D, Cohen DI. Influence of simple computerized feedback on prescription charges in an ambulatory clinic: a randomized clinical trial. Med Care 1986;24:472-81.PubMedGoogle Scholar
  82. 82.
    Meyer TJ, Van Kooten D, Marsh S, Prochazka AV. Reduction of polypharmacy by feedback to clinicians. J Gen Intern Med 1991;6:133-6.PubMedGoogle Scholar
  83. 83.
    White CW, Albanese MA, Brown DD, Caplan RM. The effectiveness of continuing medical education in changing the behaviour of physicians caring for patients with acute myocardial infarction. Ann Intern Med 1985;102:686-92.PubMedGoogle Scholar
  84. 84.
    Gehlbach SH, Wilkinson WE, Hammond WE, Clapp NE, Finn AL, Taylor WJ, Rodell M. Improving drug prescribing in a primary care practice. Med Care 1984;22:193-201.PubMedGoogle Scholar
  85. 85.
    Landgren FT, Harvey KJ, Mashford ML, Moulds RF, Guthrie B, Hemming M. Changing antiobiotic prescribing by educational marketing. Med J Australia 1988;149:595-9.PubMedGoogle Scholar
  86. 86.
    Putnam RW, Curry L. Impact of patient care appraisal on physician behaviour in the office setting. Can Med J 1985;132:1025-9.Google Scholar
  87. 87.
    Stergachis A, Fors M, Wagner EH, Sims DD, Penna P. Effect of clinical pharmacists on drug prescribing in a primary-care clinic. Am J Hosp Pharm 1987;44:525-9.PubMedGoogle Scholar
  88. 88.
    McDonald CJ, Hui SL, Smith DM, Tierney WM, Cohen SJ, Weinberger M, et al. Reminders to physicians from an introspective computer medical record: a two year randomized trial. Ann Intern Med 1984;100:130-8.PubMedGoogle Scholar
  89. 89.
    Karuza J, Calkins E, Feather J, Hershey CO, Katz L, Majeroni B. Enhancing physician adoption of practice guidelines. Dissemination of influenza vaccination guideline using a small-group consensus process. Arch Intern Med 1995;155(6):625-32.PubMedGoogle Scholar
  90. 90.
    Hopkins JA, Shoemaker WC, Greenfield S, Chang PC, McAuliffe T, Spoat RW. Treatment of surgical emergencies with and without an algorithm. Arch Surg 1980;115:745-50.PubMedGoogle Scholar
  91. 91.
    Cowan JA, Heckerling PS, Parker JB. Effect of a fact sheet reminder on performance of the periodic health examination: A randomized controlled trial. Am J Prev Med 1992;8:104-9.PubMedGoogle Scholar
  92. 92.
    Tierney WM, Hui SL, McDonald CJ. Delayed feedback of physician performance versus immediate reminders to perform preventive care: effects on physician compliance. Med Care 1986;24(8):659-66.PubMedGoogle Scholar
  93. 93.
    Lobach DF, Hammond WE. Development and evaluation of a computer-assisted management protocol (CAMP): improved compliance with care guidelines for diabetes mellitus. Proceedings-The annual symposium on computer applications in medical care 1994;787-91.Google Scholar
  94. 94.
    Gullion DS, Tschann JM, Adamson TE, Coates TJ. Management of hypertension in private practices: a randomized controlled trial in continuing medical education. J Cont Educ Health Prof 1988;8:239-55.Google Scholar
  95. 95.
    Stergachis A, Newmann WE, Williams KJ, Schnell MM. The effect of a self-care minimal intervention for colds and glue on the use of medical services. J Gen Intern Med 1990;5:23-8.PubMedGoogle Scholar
  96. 96.
    Avorn J, Soumerai SB, Everitt DE, Ross-Degnan D, Beers MH, Sherman D, Salem-Schatz SR, Fields D. A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. N Engl J Med 1992;327:168-73.PubMedGoogle Scholar
  97. 97.
    Avorn J, Soumerai SB. Improving drug-therapy decisions through educational outreach. N Engl J Med 1983;302:1457-63.Google Scholar
  98. 98.
    Bjornson DC, Rector TS, Daniels CE, Wertheimer AI, Snowdon DA, Litman TJ. Impact of drug-use review program intervention on prescribing after publication of a randomized clinical trial. Am J Hosp Pharm 1990;47:1541-6.PubMedGoogle Scholar
  99. 99.
    Denig P, Haaijer-Ruskamp FM, Zijsling DH. Impact of a drug bulletin on the knowledge, perception of drug utility, and prescriving behavior of physicians. Ann Pharmacotherapy 1990;24:87-92.Google Scholar
  100. 100.
    McDonald CJ. Use of a computer to detect and respond to clinical events: Its effect on clinician behaviour. Ann Intern Med 1976;84:162-7.PubMedGoogle Scholar
  101. 101.
    Palmer RH, Louis TA, HSu LN, Peterson HF, Rothrock JK, Strain R, Thompson MS, Wright EA. A randomized controlled trial of quality assurance in sixteen ambulatory care practices. Med Care 1985;23(6):751-70.PubMedGoogle Scholar
  102. 102.
    Steele MA, Bess DT, Franse VL, Graber SE. Cost effectiveness of two interventions for reducing outpatient prescribing costs. DICP Annals of Pharmacotherapy 1989;23:497-500.Google Scholar
  103. 103.
    McConnell TS, Cushing AH, Bankhurst AD, Healy JL, McIlvenna PA, Skipper BJ. Physician behaviour modification using claims data: Tetracycline for upper respiratory infection. West J Med 1982;137:448-50.PubMedGoogle Scholar
  104. 104.
    Maiman LA, Becker MH, Liptak GS, Nazarian LF, Rounds KA. Improving pediatricians' compliance-enhancing practices: a randomized trial. Am J Dis Child 1988;142:773-9.PubMedGoogle Scholar
  105. 105.
    McAlister NH, Covvey HD, Tong C, Lee A, Wigle ED. Randomised controlled trial of computer assisted management of hypertension in primary care. BMJ 1986;293:670-4.PubMedGoogle Scholar
  106. 106.
    Ornstein SM, Garr DR, Jenkins RG, Rust PF, Arnon A. Computer-generated physician and patient reminders. Tools to improve population adherence to selected preventive services. J Fam Pract 1991;32:82-90.PubMedGoogle Scholar
  107. 107.
    Soumerai SB, Salem-Schatz S, Avorn J, Casteris CS, Ross-Degnan D, Popovsky MA. A controlled trial of educational outreach to improve blood transfusion practice. JAMA 1993;270:961-6.PubMedGoogle Scholar
  108. 108.
    Berings D, Blondeel l, Habraken H. The effect of industry-independent drug information on the prescribing of benzodiazepines in general practice. Eur J Clin Pharmacol 1994;46:501-5.PubMedGoogle Scholar
  109. 109.
    Jones RH, Lydeard S, Dunleavey J. Problems with implementing guidelines: a randomised controlled trial of consensus management of dyspepsia. Qual Health Care 1993;2:217-21.PubMedGoogle Scholar
  110. 110.
    Weingarten MA, Bazel D, Shannon HS. Computerized protocol for preventive medicine: a controlled self-audit in family practice. Fam Pract 1989;6(2):120-4.PubMedGoogle Scholar
  111. 111.
    Johnson RE, Azevedo DJ, Campbell WH, Christensen DB. Examining physicians' drug order recording behaviour. Med Care 1978;16(5):408-16.PubMedGoogle Scholar
  112. 112.
    Becker DM, Gomez EB, Kaiser DL, Yoshihasi A, Hodge RH. Improving preventive care at a medical clinic: how can the patient help? Am J Prev Med 1989;5(6):353-9.PubMedGoogle Scholar
  113. 113.
    Rogers JL, Haring OM, Wortman PM, Watson RA, Goetz JP. Medical information systems: assessing impact in the areas of hypertension, obesity and renal disease. Med Care 1982;20(1):63-74.PubMedGoogle Scholar
  114. 114.
    Kroenke K, Pinholt EM. Reducing polypharmacy in the elderly. J Am Geriatr Soc 1990;38(1):31-6.PubMedGoogle Scholar
  115. 115.
    Coe FL, Norton E, Oparil S, Tatar A, Pullman TD. Treatment of hypertension by computer and physician-a prospective controlled study. J Chronic Dis 1977;30:81-92.PubMedGoogle Scholar
  116. 116.
    Garrett LE Jr, Hammond WE, Stead WW. The effects of computerized medical records on provider efficiency and quality of care. Meth Inform Med 1986;25:151-7.PubMedGoogle Scholar
  117. 117.
    Britton ML, Lurvey PL. Impact of medication profile review on prescribing in a general medicine clinic. Am J Hosp Pharm 1991;48:265-70.PubMedGoogle Scholar
  118. 118.
    Belcher DW. mplementing preventive services: success and failure in an outpatient trial. Arch Intern Med 1990;150:2533-41.PubMedGoogle Scholar
  119. 119.
    White PT, Pharoah CA, Anderson HR, Freeling P. Randomized controlled trial of small group education on the outcome of chronic asthma in general practice J R Coll Gen Pract 1989;39(322):182-6.PubMedGoogle Scholar
  120. 120.
    Rosser WW, Hutchison BG, McDowell I, Newell C. Use of reminders to increase compliance with tetanus booster vaccination. Can Med Assoc J 1992;146:911-7.Google Scholar
  121. 121.
    Manheim LM, Feinglass J, Hughes R, Martin GJ, Conrad K, Hughes EFX. Training house officers to be cost conscious: effects of an educational intervention on charges and length of stay. Med Care 1990;28:29-42.PubMedGoogle Scholar
  122. 122.
    Bryce1 FP, Neville RG, Crombie RG, Clark RA, McKenzie P. Controlled trial of an audit facilitator in diagnosis and treatment of childhood asthma in general practice. BMJ 1995;310:838-42.PubMedGoogle Scholar
  123. 123.
    Lipton HL, Bero LA, Bird JA, McPhee SJ. The impact of clinical pharmacists' consultations on physicians geriatric drug prescribing. Med Care 1992;30:646-58.PubMedGoogle Scholar
  124. 124.
    Anderson FA, Wheeler HB, Goldberg RJ, Hosmer DW, Forcier A, Patwardhan NA. Changing clinical practice. Prospective study of the impact of continuing medical education and quality assurance programs on use of prophylaxis for venous thromboembolism. Arch Intern Med 1994;154:669-677.PubMedGoogle Scholar
  125. 125.
    Owens NJ, Sherburne NJ, Silliman RA, Fretwell MD. The Senior Care Study. The Optimal Use of Medications in Acutely Ill Older Patients. J Am Geriatr Soc 1990;38(10):1082-7.PubMedGoogle Scholar
  126. 126.
    Billault B, Degoulet P, Devries C, Plouin PF, Chatellier G, Menard J. Use of a standardized personal medical record by patients with hypertension: a randomized controlled trial. MD Computing 1995;1:31-5.Google Scholar
  127. 127.
    Rubenstein LV, Calkins DR, Young RT, Cleary PD, Fink A, Kosecoff J, et al. Improving patient function: a randomized trial of functional disability screening. Ann Intern Med 1989;111(10):836-42.PubMedGoogle Scholar
  128. 128.
    Cheney C, Ramsdell JW. Effect of medical records' checklists on implementation of periodic health measures. Am J Med 1987;83:129-36.PubMedGoogle Scholar
  129. 129.
    Lipton HL, Bird JA. The Impact of Clinical Pharmacists' Consultations on Geriatric Patients' Compliance and Medical Care Use: A Randomized Controlled Trial. The Gerontologist 1994;34(3):307-15.PubMedGoogle Scholar
  130. 130.
    Rodman JH, Jelliffe RW, Kolb E, Tuey DB, Guzman MF de, Wagers PW et al. Clinical studies with computer-assisted initial lidocaine therapy. Arch Intern Med 1984;703-9.Google Scholar
  131. 131.
    Rosser WW, McDowell I, Newell C. Use of reminders for preventive procedures in family medicine. Can Med Assoc J 1991;145:807-14.Google Scholar
  132. 132.
    White RH, Hong R, Venook AP, Daschbach MM, Murray W, Mungall DR et al. Initiation of warfarin therapy. J Gen Intern Med 1987;2:141-8.PubMedGoogle Scholar
  133. 133.
    Billi JE, Hejna GF, Wolf FM, Shapiro LR, Stross JK. The effects of a cost-education program on hospital charges. J Gen Intern Med 1987;2:306-11.PubMedGoogle Scholar
  134. 134.
    Buffington J, Bell KM, LaForce FM and the Genesee Hospital Medical Staff. A target-based model for increasing influenza immunizations in private practice. J Gen Intern Med 1991;6:204-9.PubMedGoogle Scholar
  135. 135.
    Wilson DM, Taylor DW, Gilbert JR, Best A, Lindsay EA, Willms DG et al. A randomized trial of a family physician intervention for smoking cessation. JAMA 1988;260(11):1570-5.PubMedGoogle Scholar
  136. 136.
    Katon W, Von Korff M, Lin E, Walker E, Simon GE, Bush T et al. Collaborative Management to Achieve Treatment Guidelines. Impact on Depression in Primary Care. JAMA 1995;273(13):1026-31.PubMedGoogle Scholar
  137. 137.
    Browner WS, Baron RB, Solkowitz S, Adler LJ, Gullion DS. Physician management of hypercholesterolemia: a randomized trial of continuing medical education. West J Med 1994;161:572-8.PubMedGoogle Scholar
  138. 138.
    White KS, Lindsay A, Pryor A, Brown WF, Walsh K. Application of a computerized medical decision-making process to the problem of digoxin intoxication. JACC 1984;4(3):571-6.PubMedGoogle Scholar
  139. 139.
    Linn BS. Continuing medical education. Impact on emergency room burn care. JAMA 1980;244(6):565-70.PubMedGoogle Scholar
  140. 140.
    German PS, Shapiro S, Skinner EA, von Korff M, Klein LE, Turner RW et al. Detection and management of mental health problems of older patients by primary care providers. JAMA 1987;257(4):489-493.PubMedGoogle Scholar
  141. 141.
    Frame PS, Zimmer JG, Werth PL, Hall J, Eberly SW. Computer-based vs manual health maintenance tracking: a controlled trial. Arch Fam Med 1994;3:581-8.PubMedGoogle Scholar
  142. 142.
    Gorton TA, Cranford CO, Golden WE, Walls RC, Pawelak JE. Primary care physicians' response to dissemination of practice guidelines. Arch Fam Med 1995; 4(2): 135-42.PubMedGoogle Scholar
  143. 143.
    Peterson GM, Sugden JE. Educational program to improve the dosage prescribing of allopurinol. Med J Australia 1995;162:74-7.PubMedGoogle Scholar
  144. 144.
    McDonald CJ. Protocol-based computer reminders, the quality of care and the non-perfectability of man. N Engl J Med 1976;295(24):1351-5.PubMedGoogle Scholar
  145. 145.
    Raisch DW, Bootman JL, Larson LN, McGhan WF. Improving antiulcer agent prescribing in a health maintenance organization. Am J Hosp Pharm 1990;47:1766-73.PubMedGoogle Scholar
  146. 146.
    Klein LE, Charache P and Johannes RS. Effect of physician tutorials on prescribing patterns of graduate physicians. J Med Educ 1981;56:504-11.PubMedGoogle Scholar
  147. 147.
    Schreiner DT, Petrusa ER, Rettie CS, Kluge RM. Improving compliance with preventive medicine procedures in a house staff training program. South Med J 1988;81:1553-7.PubMedGoogle Scholar
  148. 148.
    Gutierrez G, Guiscafre J, Bronfman M, Walsh J, Martinez H, Munoz O. Changing physician prescribing patterns: evaluation of an educational strategy for acute diarrhoea in Mexico City. Med Care 1994;32(5):436-46.PubMedGoogle Scholar
  149. 149.
    Ray WA, Blazer DG, Schaffner W, Federspiel CF, Fink R. Reducing long-term diazepam prescribing in office practice: a controlled trial of educational visits. JAMA 1986;256(18):2536-9.PubMedGoogle Scholar
  150. 150.
    Mason JD, Colley CA. Effectiveness of an ambulatory care clinical pharamacist: a controlled trial. Ann Pharmacotherapy 1993;27:555-9.Google Scholar
  151. 151.
    Koepsell TD, Gurtel A, Diehr PH, Temkin NR, Helfand KH, Gleser MA et al. The Seattle evaluation of computerized drug profiles: effects on prescribing practices and resource use. Am J Public Health 1983;73:850-55.PubMedGoogle Scholar
  152. 152.
    Tape TG, Campbell JR. Computerized medical records and preventive health care: success depends on many factors. Am J Med 1993;94:619-25.PubMedGoogle Scholar
  153. 153.
    Margolis CZ, Warshawsky SS, Goldman L, Dagan O, Wirtshcafter D, Pliskin JS. Computerized algorithms and pediatricians' management of common problems in a community clinic. Acad Med 1992;67:282-4.PubMedGoogle Scholar
  154. 154.
    Fortner CR, Tarrant J and Felton HF. Report on an ambulatory clinical pharmacy program and its cost effectiveness. Group Health Journal 1985;6:3-6.Google Scholar
  155. 155.
    Rodney WM, Chopivsky P, Quan M. Adult immunization: the medical record design as a facilitator for physician compliance. J M Educ 1983;58:576-80.PubMedGoogle Scholar
  156. 156.
    Zimmerman DR, Collins TM, Lipowski EE, Sainfort F. Evaluation of a DUR intervention: a case study of histamine antagonists. Inquiry 1994;31:89-101.PubMedGoogle Scholar
  157. 157.
    Begg CB, Berlin JA. Publication bias: a problem in interpreting medical data. J R Statist Soc 1988;151:419-63.Google Scholar
  158. 158.
    Freemantle N, Wood J, Crawford F. Evidence into practice, experimentation and quasi experimentation: are the methods up to the task? J Epid and Comm Hlth 1998;52:75-81.Google Scholar
  159. 159.
    Campbell MK, Grimshaw JM. Cluster randomised trials: time for improvement. BMJ 1998;317:1171-3.PubMedGoogle Scholar
  160. 160.
    Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall, 1986.Google Scholar
  161. 161.
    Armstrong D, Reyburn H, Jones R. A study of general practitioner's reasons for changing their prescribing behaviour. BMJ 1996;949-52.Google Scholar

Copyright information

© Kluwer Academic Publishers 1999

Authors and Affiliations

  • P.S. Gill
  • M. Mäkelä
  • K.M. Vermeulen
  • N. Freemantle
  • G. Ryan
  • C. Bond
  • T. Thorsen
  • F.M. Haaijer‐Ruskamp

There are no affiliations available

Personalised recommendations