Rome Benjamin N, Dancel Ellen, Chaitoff Alexander, Trombetta Dominick, Roy Shuvro, Fanikos Paul, Germain Jayda, Avorn Jerry
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2025 Jan 2;8(1):e2453684. doi: 10.1001/jamanetworkopen.2024.53684.
Academic detailing (interactive educational outreach) is a widely used strategy to encourage evidence-based prescribing by clinicians.
To evaluate academic detailing programs targeted at improving prescribing behavior and describe program aspects associated with positive outcomes.
A systematic search of MEDLINE from April 1, 2007, through December 31, 2022, was performed for randomized trials and nonrandomized studies of academic detailing interventions to improve prescribing. Academic detailing was defined as evidence-based medication education outreach delivered interactively to individuals or small groups of prescribers. Only studies that measured prescribing outcomes were included. Two investigators independently assessed studies for risk of bias using validated assessment tools. Among all studies rated as having low risk of bias and randomized trials rated as having moderate risk of bias, the absolute change in the proportion of patients using the targeted medications and the proportion of studies that led to significant changes in 1 or more prescribing outcome were determined. The data analysis was performed between January 25, 2022, and November 4, 2024.
The 118 studies identified varied by setting (eg, inpatient, outpatient) and academic detailing delivery (eg, individual vs groups of prescribers). The most common therapeutic targets were antibiotic overuse (32 studies [27%]), opioid prescribing (24 studies [20%]), and management of mental health conditions (16 studies [14%]) and cardiovascular disease (13 studies [11%]). Most studies (66 [56%]) combined academic detailing with other interventions (eg, audit and feedback, electronic health record reminders). Among 36 studies deemed to have the lowest risk of bias, 18 interventions (50%; 95% CI, 33%-67%) led to significant improvements in all prescribing outcomes, and 7 (19%; 95% CI, 8%-36%) led to significant improvements in 1 or more prescribing outcomes. The median absolute change in the proportion of patients using the targeted medication or medications was 4.0% (IQR, 0.3%-11.3%) in the intended direction.
In this systematic review of academic detailing interventions addressing evidence-based prescribing, most interventions led to substantial changes in prescribing behavior, although the quality of evidence varied. These findings support the use of academic detailing to bring about more evidence-based prescribing in a variety of clinical settings.
学术推广（互动式教育外展）是一种广泛应用的策略，旨在鼓励临床医生进行循证处方。
评估旨在改善处方行为的学术推广项目，并描述与积极结果相关的项目方面。
对2007年4月1日至2022年12月31日期间MEDLINE数据库进行系统检索，以查找关于改善处方的学术推广干预措施的随机试验和非随机研究。学术推广被定义为以互动方式向个体或小群体的开处方者提供基于证据的药物治疗教育外展服务。仅纳入测量了处方结果的研究。两名研究人员使用经过验证的评估工具独立评估研究的偏倚风险。在所有被评为低偏倚风险的研究以及被评为中等偏倚风险的随机试验中，确定了使用目标药物的患者比例的绝对变化以及导致一项或多项处方结果发生显著变化的研究比例。数据分析于2022年1月25日至2024年11月4日进行。
纳入的118项研究在设置（如住院、门诊）和学术推广方式（如针对个体开处方者还是开处方者群体）方面存在差异。最常见的治疗目标是抗生素过度使用（32项研究[27%]）、阿片类药物处方（24项研究[20%]）、心理健康状况管理（16项研究[14%]）和心血管疾病（13项研究[11%]）。大多数研究（66项[56%]）将学术推广与其他干预措施（如审核与反馈、电子健康记录提醒）相结合。在36项被认为偏倚风险最低的研究中，18项干预措施（50%；95%CI，33%-67%）使所有处方结果都有显著改善，7项（19%；95%CI，8%-36%）使一项或多项处方结果有显著改善。使用目标药物的患者比例的中位数绝对变化在预期方向上为4.0%（IQR，0.3%-11.3%）。
在这项针对循证处方的学术推广干预措施的系统评价中，大多数干预措施使处方行为发生了实质性变化，尽管证据质量各不相同。这些发现支持在各种临床环境中使用学术推广来实现更多的循证处方。
