CADTH: Rx for Change Database
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Browse » Professional: Audit and Feedback » Review » Individual Studies
Changing medication use in managed care: a critical review of
the available evidence
Pearson SA, Ross-Degnan D, Payson A, Soumerai SB. Changing medication use in managed care: a critical review of
the available evidence. Am J Manag Care 2003 9(11):715-31. [PubMed]
Sources of funding: HMO Research Network Center for Education and Research on Therapeutics, Harvard Pilgrim
Health Care Foundation.
Main author affiliation: Dr. S. Soumerai, Harvard Medical School and Harvard Pilgrim Health Care, Boston,
Massacheusetts, USA
Q: Can the quality of medication use be improved in managed care organisations?
BACKGROUND
The authors assessed the effect of a variety of
interventions on prescription of medications. Many of
the interventions targeted patients and are beyond the
scope of this abstract. Multifaceted interventions were
the most commonly assessed interventions.
INCLUSION
Individual studies from systematic review
SEARCH FOR EVIDENCE: 1966 to June 2001
INCLUDED STUDIES: 48
STUDIES RELATED TO PRESCRIBING: 18
STUDY DESIGN: RCT, CBA, ITS.
STUDY CHARACTERISTICS:
Target population: Physicians, Nurses,
Pharmacists.
Intervention(s): Multifaceted, Audit and
feedback, Distribution of educational
materials, Reminders, Patient-mediated
interventions
Setting: Primary care practices, Outpatient
clinics, Ownership - Private, Academic - Not
specified/unclear.
Patients Reviewed: Any type of patient.
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CADTH: Rx for Change Database
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Drug Related Outcome Categories:
Appropriate use, Cost containment.
Other Outcome Categories: Other resource
use, Other.
AUTHORS' ANALYSIS OF DATA:
Vote counting based on direction of effect.
REVIEW QUALITY: 4
RESULTS - OVERALL
The authors of this review did not identify any potential
effect modifiers nor identify any issues with unit of
analysis errors. It is difficult to assess unit of
randomization for many of the included studies. There was
insufficient evidence for audit and feedback, distribution
of education materials, reminders and patient mediated
interventions for appropriate care. Multifaceted
interventions were generally effective for appropriate
care.
RESULTS - RELATED TO PRESCRIBING
There was insufficient evidence for audit and feedback,
reminders and patient mediated interventions for
appropriate use and for distribution of education materials
for cost containment. Insufficient evidence exists for
reminders for appropriate use. Multifaceted interventions
were generally effective for appropriate use.
CONCLUSIONS - OVERALL
Medium quality review. Multifaceted interventions were
generally effective for appropriate care.
CONCLUSIONS - RELATED TO PRESCRIBING
Medium quality review. Multifaceted interventions may be
generally effective for all behaviours and prescribing
behaviours.
EFFECTIVENESS
Medium quality review. Multifaceted interventions maybe
have mixed effects for appropriate care. Multifaceted
interventions may be generally effective for appropriate
use. There was insufficient evidence for prescribing
outcomes for the other assessed interventions.
Table of Results
Comparison
Outcome
N
Analysis
Results
Audit and feedback vs
control
Appropriate
care
1
Vote counting
based on
Vote counting 1/1 RCT study favoured
intervention: insufficient evidence.
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CADTH: Rx for Change Database
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direction of effect
Prescribing Outcomes:
Appropriate use:
Vote counting 0/1 RCT study favoured
intervention, insufficient evidence.
Audit and feedback vs
distribution of education
materials
Appropriate
use
1
Vote counting
based on
direction of effect
Vote counting 0/1 RCT study favoured
intervention, insufficient evidence.
Distribution of
education materials vs
control
Cost
Containment
1
Vote counting
based on
direction of effect
Vote counting 1/1 study (non RCT)
favoured intervention, insufficient
evidence.
Multifaceted vs control
Appropriate
use
13
Vote counting
based on
direction of effect
Vote counting 12/13 studies (mixed
designs) favoured intervention, generally
effective. Vote counting 5/5 RCT studies
favoured intervention, generally effective.
Prescribing Outcomes: Appropriate use:
Vote counting, 6/7 studies (mixed designs)
favoured intervention, 1 study with mixed
results: generally effective. Vote counting,
6/7 studies (mixed designs) favoured
intervention, 1 study with mixed results:
generally effective. Vote counting 5/5 RCT
studies favoured intervention, generally
effective. Cost Containment: Vote
counting, 3/3 studies (mixed designs)
favoured intervention, generally effective.
Vote counting, 1/1 RCT studies favoured
intervention, insufficient evidence.
Reminders vs control
Appropriate
use
1
Vote counting
based on
direction of effect
Vote counting 0/1 RCT study favoured
intervention, 1 study with mixed results:
insufficient evidence.
Patient-mediated
interventions vs control
Appropriate
care
1
Vote counting
based on
direction of effect
Vote counting 0/1 study (non RCT)
favoured intervention, insufficient
evidence.
Prescribing Outcomes:
Appropriate use: Vote counting, 1/1 study
favoured intervention, insufficient
evidence.
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Last Updated January 7, 2008
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