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EVIDENCE-BASED MEDICINE

Systematic Review of Interventions to Improve Prescribing

Research Officer, School of Pharmacy, The University of Queensland, Brisbane, Australia

Desley Hegney, PhD

Director, UQ/Blue Care Research & Practice Development Centre, School of Nursing & Midwifery, The University of Queensland

Claire Jackson, MBBS MPH

Professor of General Practice, School of Medicine, The University of Queensland

Margaret Williamson, MPH

Manager, Research and Development, National Prescribing Service Ltd., Surry Hills, Australia

Judith M Mackson, MMedSci

Manager, Education and Quality Assurance Program, National Prescribing Service Ltd.

Karin Gurman, MPH

Program Officer, Education and Quality Assurance Program, National Prescribing Service Ltd.

Wayne Hall, PhD

Professor of Public Health Policy, School of Population Health, The University of Queensland

Susan E Tett, PhD

Deputy Executive Dean & Associate Dean (Research), Faculty of Health Sciences, The University of Queensland

Reprints: Dr. Tett, Faculty of Health Sciences, The University of Queensland, Brisbane, QLD 4072, Australia, fax 61 7 3365 5533, s.tett{at}uq.edu.au

OBJECTIVE: To update 2 comprehensive reviews of systematic reviews on prescribing interventions and identify the latest evidence about the effectiveness of the interventions.

DATA SOURCES: Systematic searches for English-language reports of experimental and quasi-experimental research were conducted in PubMed (1951–May 2007), EMBASE (1974–March 2008), International Pharmaceutical Abstracts (1970–March 2008), and 11 other bibliographic databases of medical, social science, and business research. Following an initial title screening process and after selecting 6 specific intervention categories (identified from the previous reviews) in community settings, 2 reviewers independently assessed abstracts and then full studies for relevance and quality and extracted relevant data using formal assessment and data extraction tools. Results were then methodically incorporated into the findings of the 2 earlier reviews of systematic reviews.

DATA SELECTION AND SYNTHESIS: Twenty-nine of 26,314 articles reviewed were assessed to be of relevant, high-quality research. Audit and feedback, together with educational outreach visits, were the focus of the majority of recent, high-quality research into prescribing interventions. These interventions were also the most effective in improving prescribing practice. A smaller number of studies included a patient-mediated intervention; this intervention was not consistently effective. There is insufficient recent research into manual reminders to confidently update earlier reviews and there remains insufficient evidence to draw conclusions regarding the effectiveness of local consensus processes or multidisciplinary teams.

CONCLUSIONS: Educational outreach as well as audit and feedback continue to dominate research into prescribing interventions. These 2 prescribing interventions also most consistently show positive results. Much less research is conducted into other types of interventions and there is still very little effort to systematically test why interventions do or do not work.

Key Words: academic detailing, prescribing interventions, quality improvement

Published Online, March 3, 2009. www.theannals.com, DOI 10.1345/aph.1L488