Hux J E, Melady M P, DeBoer D
Institute for Clinical Evaluative Sciences, Toronto, Ont.
CMAJ. 1999 Aug 24;161(4):388-92.
Antibiotics are a medication class for which inappropriate prescribing is frequently described. We sought to assess the effectiveness of a mailed intervention combining confidential prescribing feedback with targeted educational bulletins in increasing the use of less expensive, first-line antibiotics by practising physicians.
The participants were 251 randomly selected primary care physicians from southern Ontario who consented to participate (135 in the feedback group and 116 in the control group). Prescribing data were obtained from the claims database of the Ontario Drug Benefit program, which covers all Ontarians over age 65 years for drugs selected from a minimally restrictive formulary. Confidentially prepared profiles of antibiotic prescriptions coupled with guidelines-based educational bulletins were mailed to the intervention group every 2 months for 6 months. The control group received no intervention until after completion of the study. The main outcome measures were change from baseline in physician's median antibiotic cost and proportion of episodes of care in which a prespecified first-line antibiotic was used first.
The median prescription cost of about $11 remained constant in the feedback group but rose in the control group (change of $0.05 v. $3.37, p < 0.002). First-line drug use increased in the feedback group but decreased in the control group (change of 2.6% v. -1.7%, p < 0.01). In a mailed survey of 100 feedback recipients (response rate 76%), 82% indicated that they would participate readily in another, similar program.
A simple program of confidential feedback and educational materials blunted cost increases, increased the use of first-line antibiotics and was highly acceptable to Ontario primary care physicians.
抗生素是一类经常被描述为存在不适当处方情况的药物。我们试图评估一种邮寄干预措施的效果，该措施将保密的处方反馈与有针对性的教育公告相结合，以增加执业医师对成本较低的一线抗生素的使用。
参与者是从安大略省南部随机挑选的251名同意参与的初级保健医生（反馈组135名，对照组116名）。处方数据来自安大略省药物福利计划的理赔数据库，该计划涵盖所有65岁以上的安大略省居民，涉及从限制最少的处方集里选择的药物。每隔2个月向干预组邮寄一次基于指南的教育公告以及保密编制的抗生素处方概况，为期6个月。对照组在研究结束前不接受任何干预。主要结局指标是医生抗生素中位数成本相对于基线的变化，以及首次使用预先指定的一线抗生素的护理事件比例。
反馈组的处方中位数成本约11美元保持不变，而对照组则有所上升（变化为0.05美元对3.37美元，p<0.002）。反馈组一线药物使用增加，而对照组则减少（变化为2.6%对-1.7%，p<0.01）。在对100名反馈接收者进行的邮寄调查中（回复率76%），82%的人表示他们愿意随时参与另一个类似的项目。
一个简单的保密反馈和教育材料项目抑制了成本增加，增加了一线抗生素的使用，并且安大略省的初级保健医生对其接受度很高。
