Erramouspe John, Bailey Jason M, Cleveland Kevin W, Casperson Kerry, Hunt Timothy L, Cady Paul S
Pharmacy Practice and Administrative Sciences, College of Pharmacy, Idaho State University, Pocatello 83209-8333, USA.
Consult Pharm. 2006 Aug;21(8):636-42. doi: 10.4140/tcp.n.2006.636.
To observe if medical providers alter their prescribing patterns of three relatively expensive categories of medications provided as samples by manufacturers (focus medications) when they receive additional education from pharmacists concerning the appropriate use of lower cost alternatives (counter samples) that are made available to dispense.
Pretest, post-test with a control group.
Two rural, private care clinics in southeastern Idaho providing immediate care services.
Eight medical providers at a clinic where interventions were employed (active intervention group) and seven medical providers in a clinic where no interventions occurred (control group).
Medical providers in the active intervention group had: 1) education from pharmacists concerning the appropriate use of lower-cost alternatives compared with expensive focus medications 2) counter samples and patient sample handouts available to dispense to patients at their own discretion.
The percentage of the total yearly prescriptions for nonsteroidal anti-inflammatory drugs (NSAIDs), antihistamines, and acid-relief medications that consisted of focus-COX-2 NSAIDs, nonsedating antihistamines, and proton pump inhibitors (PPIs), respectively.
The prescribing behavior of medical providers in the active intervention and control groups were significantly different at baseline in all three categories of focus medications. This suggested that the results should focus on changes across the two years of the study within the intervention and control groups rather than across the two groups. Medical providers in the intervention group significantly decreased the use of COX-2 NSAID prescriptions relative to total NSAID prescriptions following active intervention (38.9% in year 1 versus 23.7% in year 2, P < 0.05). Over the same two time periods, a nonstatistically significant decrease in COX-2 NSAID prescribing was seen at the control site (67.5% versus 62%, P > 0.05). Education and counter sampling did not stop medical providers from significantly increasing the total yearly prescriptions for antihistamines and acid-relief medications that consisted of focus-nonsedating antihistamines (86.7% versus 93.1%, P < 0.05) and PPIs (68.9% versus 86.2%, P < 0.05). Statistically significant increases in the prescribing of focus-nonsedating antihistamines (77.9% versus 98.3%, P < 0.05) and PPIs (77.5% versus 91.4%, P < 0.05) were also observed in the control group.
Education by pharmacists, combined with access to counter samples, may or may not have an effect on medical provider prescribing, depending on the category of medication targeted for cost control.
观察医疗服务提供者在接受药剂师关于使用可获得的低成本替代药物（对照样品）的适当方法的额外教育后，是否会改变其对制造商提供的三类相对昂贵的样品药物（重点药物）的处方模式。
有对照组的前测、后测。
爱达荷州东南部的两家提供即时护理服务的农村私立诊所。
一家采用干预措施的诊所的8名医疗服务提供者（积极干预组）和一家未进行干预的诊所的7名医疗服务提供者（对照组）。
积极干预组的医疗服务提供者接受了：1）药剂师关于与昂贵重点药物相比使用低成本替代药物的适当方法的教育；2）可自行决定分发给患者的对照样品和患者样品手册。
非甾体抗炎药（NSAIDs）、抗组胺药和抗酸药的年度总处方中分别由重点COX-2 NSAIDs、非镇静抗组胺药和质子泵抑制剂（PPIs）组成的百分比。
在所有三类重点药物中，积极干预组和对照组的医疗服务提供者的处方行为在基线时存在显著差异。这表明结果应关注干预组和对照组在研究的两年内的变化，而不是两组之间的变化。积极干预后，干预组的医疗服务提供者相对于NSAIDs总处方显著减少了COX-2 NSAID处方的使用（第1年为38.9%，第2年为23.7%，P<0.05）。在同一两个时间段内，对照组的COX-2 NSAID处方量有非统计学意义的下降（67.5%对62%，P>0.05）。教育和对照样品发放并没有阻止医疗服务提供者显著增加由重点非镇静抗组胺药（86.7%对93.1%，P<0.05）和PPIs（68.9%对86.2%，P<0.05）组成的抗组胺药和抗酸药的年度总处方量。对照组中重点非镇静抗组胺药（77.9%对98.3%，P<0.05）和PPIs（77.5%对91.4%，P<0.05）的处方量也有统计学意义的增加。
药剂师的教育，结合对照样品的获取，可能会也可能不会对医疗服务提供者的处方产生影响，这取决于针对成本控制的药物类别。
