Gill P S, Mäkelä M, Vermeulen K M, Freemantle N, Ryan G, Bond C, Thorsen T, Haaijer-Ruskamp F M
Department of Primary Care and General Practice, University of Birmingham, UK.
Pharm World Sci. 1999 Aug;21(4):158-67. doi: 10.1023/a:1008719129305.
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 < or = 0.05 between the intervention and control groups. Negative studies (-) showed a significant change in the opposite direction and inconclusive studies (approximately) showed no significant change compared to control or no overall positive findings. We identified 79 eligible 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.
本综述的目的是确定能够改变医生处方行为的干预措施，并得出实践和进一步研究的结论。相关研究（将处方作为一种行为改变）来自Cochrane有效专业实践协作网维护的研究数据库。通过搜索以下数据库以获取相关研究报告来保持该登记册的最新状态：卫生与社会保障部数据库；EMBASE；医学索引数据库；SIGLE；继续医学教育资源数据库（1975 - 1994年），以及相关主题的参考文献，手动检索关键期刊并与内容领域专家进行个人联系。纳入了采用干预前后测量的随机对照试验和非等效组设计。结局指标为研究作者所使用的指标。对于每项研究，我们确定这些指标是阳性、阴性还是无定论。阳性研究（+）是指那些在干预组和对照组之间，在p≤0.05水平上所测量的大多数结局显示出具有统计学意义变化的研究。阴性研究（-）显示出相反方向的显著变化，而无定论的研究（≈）与对照组相比没有显著变化或没有总体阳性结果。我们确定了79项符合条件的研究，这些研究描述了96种改变处方行为的单独干预措施。在这些干预措施中，49项（51%，41% - 61%）与对照组相比显示出显著的阳性变化，但由于宽泛且重叠的置信区间，对具体干预措施的解释受到限制。
