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Changing prescribing behaviours with educational outreach: an overview of evidence and practice

机译:通过教育宣传改变处方行为:证据和实践概述

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General practitioners (GPs), or family practitioners, are tasked with prescribing medications that can be harmful to the community if they are inappropriately prescribed or used (e.g. opioids). Educational programs, such as educational outreach (EO), are designed to change the behaviour of health professionals. The purpose of this study was to identify the efficacy of EO programs at changing the prescribing behaviour of GPs. This study included an evidence and practice review, comprising a rapid review supplemented by interviews with people who are familiar with EO implementation for regulation purposes. Seven databases were searched using terms related to health professionals and prescribing. Systematic and narrative reviews published in English after 2007 were included. Non-statistical analysis was used to report intervention efficacy. Three government representatives participated in semi-structured interviews to aid in understanding the relevance of review findings to the Victorian context. Interviews were transcribed verbatim and thematically analysed for emerging themes. Fourteen reviews were identified for the evidence review. Isolated (e.g. EO program delivered by itself) and multifaceted (e.g. EO program supplemented by other interventions) programs were found to change prescribing behaviours. However, limited evidence suggests that EO can successfully change prescribing behaviours specific to GPs. Isolated EO can successfully change health professional prescribing behaviours, although cheaper alternatives such as letters might be just as effective. Multifaceted EO can also successfully change health professional prescribing behaviours, especially in older adults, but it remains unclear as to what combination of interventions works best. Success factors for EO reported by government representatives included programs having practical rather than didactic foci; making EO compulsory; focussing EO on preventing adverse events; using monetary or professional development incentives; and in-person delivery. Educational outreach can successfully change prescribing behaviours but evidence specific to GPs is lacking. Key characteristics of EO that could optimise success include ensuring the EO program is tailored, involves practical learning and uses incentives that are meaningful to clinicians.
机译:全科医生(GPs)或家庭医生的任务是开处方药,如果处方或使用不当,可能对社区有害(例如阿片类药物)。教育计划,例如教育推广(EO),旨在改变卫生专业人员的行为。这项研究的目的是确定EO程序在改变GP处方行为方面的功效。这项研究包括证据和实务审查,包括快速审查,并辅之以对出于法规目的而熟悉EO实施的人士的采访。使用与卫生专业人员和处方相关的术语搜索了七个数据库。包括2007年后以英文出版的系统和叙述性评论。非统计分析用于报告干预效果。三名政府代表参加了半结构化访谈,以帮助理解审查结果与维多利亚时代背景的相关性。采访被逐字记录,并针对新兴主题进行专题分析。确定了14篇评论进行证据评论。发现孤立的(例如,由其自身提供的EO程序)和多方面的(例如,由其他干预措施补充的EO程序)程序会改变规定的行为。但是,有限的证据表明,EO可以成功改变GP的处方行为。孤立的EO可以成功地改变卫生专业人员的处方行为,尽管较便宜的替代方法(如信件)可能同样有效。多方面的EO还可以成功改变卫生专业人员的处方行为,尤其是在老年人中,但对于哪种干预措施效果最好,目前尚不清楚。政府代表报告的EO成功因素包括具有实际重点而非教学重点的计划;强制执行EO;将EO重点放在预防不良事件上;使用金钱或专业发展激励措施;和亲自送货。教育宣传可以成功地改变处方行为,但缺乏针对全科医生的证据。可以优化成功的EO的关键特征包括确保EO计划量身定制,涉及实际学习并使用对临床医生有意义的激励措施。

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