Modifying prescribing of regulated analgesics
Online posting: January 28, 1997
Published in print: Mar. 1, 1997 (CMAJ 1997;156:636)
Re: Effectiveness of notification and group education in modifying
prescribing of regulated analgesics, by John F. Anderson, MD,
Kimberley L. McEwan, PhD, and William P. Hrudey, MD, Can Med
Assoc J 1996;154:31-9 [abstract / résumé]
In response to our previous article, it has been suggested
that longer follow-up may reveal important differences between
the education and the notification intervention with respect to
reducing prescribing of regulated analgesics.[1] To this end, we
have examined prescribing data for the 7 to 12 months after the
intervention by conducting a 1-way analysis of variance (ANOVA)
of the difference scores in prescribing between baseline and 1-
year follow-up. The original article had examined prescribing
patterns after only 6 months in 3 groups of physicians: those who
underwent group education, those who were notified of their
prescribing status, and those subject to no intervention (the
control group). At that time, prescribing of analgesics was
significantly reduced in both intervention groups compared with
the control group, but no statistically significant difference
was found between the education group and the notification group.
Results of the ANOVA based on 1-year follow-up data revealed
no overall difference between groups, suggesting that reductions
in prescribing seen after 6 months diminished over time.
Although, at 1-year follow-up, the prescribing practices of the
physicians exposed to the interventions were no longer
significantly different from those of the control group, there
was a trend similar to that found in the first study. The mean
difference scores were aligned with the intensity of the
intervention, with education showing the greatest reduction and
no intervention (the control group) showing the least. We also
noted that 76% of the education group, 65% of the notification
group and 53% of control group continued to prescribe narcotic
analgesics at a rate lower than their rate at baseline. In a
larger sample, these differences may have emerged as significant.
We attempted to determine whether group education was superior
to notification in reducing prescribing of regulated analgesics
over a 1-year period in a sample of 49 physicians and found no
support for this hypothesis. We acknowledge, however, that our
limited sample size may not have been an adequate test of
Britten's[1] hypothesis. The durability of interventions in
altering prescribing warrants further investigation.
John F. Anderson, MD
Adult Clinical and Addictions Services Branch
British Columbia Ministry of Health and Ministry Responsible
for Seniors
Victoria, BC
Kimberley L. McEwan
Department of Psychology
University of Victoria
Adult Clinical and Addictions Services Branch
British Columbia Ministry of Health and Ministry Responsible
for Seniors
Victoria, BC
Reference
1. Britten N. Letter from a licensing body and group
education reduced prescribing of regulated analgesics
[commentary]. ACP J Club 1996;125:25.
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