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CLINICAL SERVICES

What Interventions Should Pharmacists Employ to Impact Health Practitioners' Prescribing Practices?

Pharmacy Resident, Department of Pharmacy, London Health Sciences Centre, London, Ontario, Canada

Payal Patel, PharmD

Assistant Professor, Faculty of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada

Janet E Martin, PharmD

Coordinator, Drug Use Management & Evidence Based Medicine, Pharmacy Services, London Health Sciences Centre; Associate Scientist, Lawson Health Research Institute; Lecturer, Department of Physiology & Pharmacology, University of Western Ontario, London

Reprints: Dr. Patel, 202 Pharmacy Building, 50 Sifton Rd., University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada, fax 204/474-7617, patelp{at}cc.umantioba.ca

OBJECTIVE: To determine which interventions are effective in influencing health practitioners' prescribing practices and explore differences in intervention complexity, setting, sustainability, cost effectiveness, and impact on patient outcomes.

METHODS: A systematic search for English-language systematic reviews was performed in MEDLINE, Cumulative Index of Nursing and Allied Health Literature, EMBASE, and the Cochrane Library from the date of inception to July 2005 using search terms in accordance with Cochrane recommendations. Included reviews were required to clearly report a search strategy, inclusion/exclusion criteria, literature assessment criteria, and methods for synthesizing or summarizing information and references. Two reviewers independently identified studies for inclusion, assessed study quality, and extracted relevant information. Interventions were classified as consistently effective, inconsistently effective, and effectiveness uncertain.

RESULTS: Thirty-four of 4585 titles reviewed met the inclusion criteria. Quality scores ranged from 70% to 100%. Consistently effective interventions included reminders (manual and computerized), audit and feedback, educational outreach visits, organizational strategies, and patient-mediated interventions. Inconsistently effective interventions included computer decision support systems and educational meetings. Multi-faceted interventions were consistently shown to be more efficacious than single interventions. Limited data precluded exploration of the effects of interventions in different settings, sustainability of effect, cost effectiveness, and patient clinical outcomes.

CONCLUSIONS: Interventions that are most effective for impacting prescribing practice include audit and feedback, reminders, educational outreach visits, and patient-mediated interventions. To maximize impact, pharmacists' efforts to positively impact prescribing practices should focus on these intervention types rather than relying primarily on passive didactics or dissemination of guidelines.

Key Words: healthcare quality assurance, professional practice

Published Online, August 8, 2006. www.theannals.com, DOI 10.1345/aph.1G300

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