Canadian Medical Association Journal 1996; 154: 31-39
Paper reprints of the full text may be obtained from: Dr. John F. Anderson, Provincial medical advisor, Adult Clinical and Addictions Services Branch, British Columbia Ministry of Health and Ministry Responsible for Seniors, 3rd floor, 1810 Blanshard St., Victoria BC V8T 4J1; fax 604 952-0808
Design: Randomized controlled trial conducted from Dec. 1, 1992, to Dec. 31, 1993.
Setting: Nonacademic primary care practices in British Columbia.
Participants: Fifty-four physicians randomly selected from a group of 100 physicians who had written a number of prescriptions for regulated drugs more than than two standard deviations above the mean number of prescriptions written for such drugs in 1992. Any physician who was unable to participate was replaced from the original group of 100 before the study began. Five subjects did not complete the study and were not included in the analysis.
Interventions: Participants were randomly assigned to three groups: those in the first group received a written notification of excessive prescribing and attended a 1-day group-education activity, those in the second group received a written notification of excessive prescribing only and those in the third group were not subject to any intervention and were unaware that their prescribing had received special notice.
Outcome measure: Mean number of prescriptions for regulated analgesics issued per physician in the 6 months before and the 6 months after the interventions.
Results: Physicians in the group that attended the education intervention wrote, on average, 33% fewer prescriptions after the intervention, whereas physicians in the group that received only written notification wrote 25% fewer prescriptions, on average, after the intervention. No change in prescribing was shown in the control group. The differences in rates of prescribing of regulated analgesics between each intervention group and the control group were statistically significant (p < 0.01). The difference in the rate of prescribing between the two intervention groups was not significant.
Conclusions: Group education and notification of prescriber status as well as notification alone significantly reduced prescribing of regulated analgesics. Hence, feedback on a physician's prescribing pattern may be a practical and less costly alternative to direct educational intervention in moderating the prescribing of regulated analgesics. The results do not, however, imply that notification is as effective as education in improving overall patient care. A follow-up study comparing the duration of the effect of the educational intervention with that of notification alone is warranted.