A Model of Methods for Influencing Prescribing: Part II. A Review of Educational Methods, Theories of Human Inference, and Delineation of the Model
DICPPublished 1 May 1990
Dennis W. Raisch
Citations51
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
This article reviews well-controlled studies of educational efforts, describes and relates theories of human inference to these studies, and delineates a model of methods for influencing prescribing.
Abstract
The purpose of this literature review is to develop a model of methods used to influence prescribing. This article reviews well-controlled studies of educational efforts, describes and relates theories of human inference to these studies, and delineates a model of methods for influencing prescribing. The model can be used to help explain the success or failure of various programs and as a framework for developing and testing methods to influence prescribing.
Keywords
MedicineHealth Professions
ScienceJudgment under Uncertainty: Heuristics and Biases
28,003 Citations1974Amos Tversky, Daniel Kahneman
Three heuristics that are employed in making judgements under uncertainty are described: representativeness, availability of instances or scenarios, which is often employed when people are asked to assess the frequency of a class or the plausibility of a particular development.
Understanding Attitudes and Predicting Social Behavior
26,054 Citations1980Icek Ajzen, Martin Fishbein
Judgment under Uncertainty: Heuristics and Biases
23,088 Citations1975Amos Tversky, Daniel Kahneman
World Scientific handbook in financial economic seriesChoices, Values, and Frames
5,406 Citations2013Daniel Kahneman, Amos Tversky
New England Journal of MedicineOn the Elicitation of Preferences for Alternative Therapies
1,659 Citations1982Barbara J. McNeil, Stephen G. Pauker +2 more
It is suggested that an awareness of variations in the way information is presented to patients influence their choices between alternative therapies could help reduce bias and improve the quality of medical decision making.
New England Journal of MedicineImproving Drug-Therapy Decisions through Educational Outreach
862 Citations1983Jerry Avorn, Stephen B. Soumerai
Physicians who were offered personal educational visits by clinical pharmacists along with a series of mailed "unadvertisements" reduced their prescribing of the target drugs by 14 per cent as compared with controls, resulting in substantial cost savings.
Annals of Internal MedicineImproved Outcomes in Hypertension After Physician Tutorials
396 Citations1976Thomas S. Inui, EDWARD L. YOURTEE +1 more
The personal physician, if he is provided with strategies for identifying the noncompliant patient and for intervening in that behavior, can apply a stimulus to his patients that results in improved compliance and better control of hypertension.
Social Science & MedicineDoctors' decisions and the cost of medical care
334 Citations1987Jeffrey H. Samet
JAMAImproving antibiotic prescribing in office practice. A controlled trial of three educational methods
233 Citations1983William Schaffner
Medical Decision MakingPhysician and Medical Student Bias in Evaluating Diagnostic Information
227 Citations1981Thomas S. Wallsten
Reanalysis of a previously published experiment, in which radiologists evaluated excretory urograms, shows that the radiologists' assessment of the likelihood of a tumor being present was inappropriately influenced by the importance of ruling the tumor out.
JAMADoes a Mailed Continuing Education Program Improve Physician Performance?
162 Citations1986Cara Evans
A randomized trial of a mailed continuing education program on hypertension for primary care physicians showed no lasting effect on physician knowledge and no influence on performance in lowering the blood pressures of patients referred from screening.
Academic MedicineAn educational program to modify laboratory use by house staff
161 Citations1977John M. Eisenberg
The results emphasize the need to measure the long-term outcome of educational programs aimed at modifying the clinical behavior of physicians and to institute follow-up programs to ensure that an educational effort will have a lasting effect.
JAMAImproving Antibiotic Prescribing in Office Practice
157 Citations1983William Schaffner
A statewide controlled trial of three methods to improve antibiotic prescribing in office practice: a mailed brochure, a drug educator visit, and a physician visit that produced strong attributable reductions in prescribing of both drug classes.
JAMAThe failure of physician education as a cost containment strategy. Report of a prospective controlled trial at a university hospital
155 Citations1984Sissel Schroeder
Academic MedicineHeuristics and biases in medical decision-making
136 Citations1978Don E. Detmer, Dennis G. Fryback +1 more
Medical CareImproving Drug Prescribing in a Primary Care Practice
128 Citations1984Stephen H. Gehlbach, William E. Wilkinson +5 more
The feedback model improved rates of generic prescribing but should be evaluated for broader areas of physician prescribing.
Medical CareComputer-based Audit to Detect and Correct Overutilization of Laboratory Tests
117 Citations1977John M. Eisenberg, Sankey V. Williams +3 more
A computer-based system to detect inappropriate use of the clinical laboratory and a program of physician education to reduce overutilization are developed and tested, but the program of notification and education of physicians is not effective in reducing over utilization.
JAMAThe Failure of Physician Education as a Cost Containment Strategy
116 Citations1984Steven A. Schroeder
It is concluded that, in the absence of other cost containing incentives, physician education alone is not an effective hospital cost containment strategy.
Arthritis & RheumatismEvaluation of a continuing education program in rheumatoid arthritis
116 Citations1980Jeoffrey K. Stross, Giles G. Bole
Although inpatient and outpatient audits of physician records demonstrated little change in three control communities, substantial improvement in the utilization of diagnostic procedures and patient management was documented in the three intervention communities utilizing the influential physicians.
Medical CareDoes Cost Information Availability Reduce Physician Test Usage?
111 Citations1982David I. Cohen, Paul K. Jones +2 more
Four similar teams of physicians associated with similar inpatient units and randomly assigned patients were used to study the effect of providing physicians with cost information about their use of lab tests and x-rays.
JAMAFeedback Reduces Test Use in a Health Maintenance Organization
106 Citations1986Donald M. Berwick
Overall use fell by 14.2% in a 16-week period during which physicians received confidential feedback on their individual rates of use compared with peers (cost feedback), and similar feedback on rates of abnormal test results (yield feedback) and a program of test-specific education failed to show a consistent effect.
The American Journal of MedicineComparison of physicians' decisions regarding estrogen replacement therapy for menopausal women and decisions derived from a decision analytic model
103 Citations1986Arthur S. Elstein, Gerald B. Holzman +6 more
The increased probability of early detection of cancer by regular follow-up was systematically incorporated into the decision analysis but apparently neglected in unaided clinical judgment, which follows the principle of minimizing the most important risk, regardless of its probability.
Journal of Clinical PsychologyAnchoring and publicity effects in clinical judgment
93 Citations1983Myrna L. Friedlander, Susan J. Stockman
Results among an experienced sample of clinicians indicated significant anchoring in one case but not the other, which suggests a clinical bias to disregard pathognomonic data about a client who is seen initially as less disturbed.
Journal of Marketing ResearchAn Evaluation of the Expectancy Value Model of Attitude Measurement for Physician Prescribing Behavior
86 Citations1974Gilbert D. Harrell, Peter Bennett
Findings from research using expectancy value and normative belief measures to predict physician drug brand preference and purchases are presented and extensions to the model are presented for marketing applications.
Archives of Internal MedicineEffect of Cost Education, Cost Audits, and Faculty Chart Review on the Use of Laboratory Services
80 Citations1983G. Everett
Among the methods examined, faculty chart review seems to be the most effective method of reducing the amount of laboratory testing performed by house staff.
American Journal of Public HealthReducing antipsychotic drug prescribing for nursing home patients: a controlled trial of the effect of an educational visit.
79 Citations1987Wayne A. Ray, Dan G. Blazer +2 more
A statewide, controlled trial of the efficacy of an educational visit in reducing antipsychotic drug prescribing for nursing home patients found that this negative finding suggests that future interventions address factors within the nursing home which encourage antipsychotics drug use.
Medical CareThe Effects of Price Information on Physicians?? Test-Ordering Behavior
76 Citations1982K. Michael Cummings, Kenneth B. Frisof +2 more
The study results show that for each of the four cases, the average number of diagnostic tests ordered was significantly lower in the price-information group than in the control group, and an average reduction in the cumulative cost of tests ordered per patient is shown.
Medical CareInfluence of Simple Computerized Feedback on Prescription Charges in an Ambulatory Clinic
71 Citations1986Charles O. Hershey, Dan K. Porter +2 more
The goal was to reduce total prescribing charges and produce a meaningful financial result, and the intervention reduced the mean charge for a prescription by 6.7% but with a long latent period and minimal impact on resident knowledge of drug charges.
PubMedEffects of an educational feedback strategy on physician utilization of thyroid function panels.
67 Citations1979Rhyne Rl, Gehlbach Sh
Results obtained in this and other studies suggest that other factors compete with educational approaches in motivating physician behavior, and these override rational decision making.
Medical CareDrug Choice as a Problem-solving Process
61 Citations1985Richard Segal, Charles D. Helper
Academic MedicineEffect of physician tutorials on prescribing patterns of graduate physicians
53 Citations1981Lawrence E. Klein, Patricia Charache +1 more
A prospective controlled trial of a specific form of educational intervention, the physician tutorial, suggests that educational programs can be effective in modifying graduate physician prescribing practices.
DICPA Model of Methods for Influencing Prescribing: Part I. A Review of Prescribing Models, Persuasion Theories, and Administrative and Educational Methods
51 Citations1990Dennis W. Raisch
This article reviews prescribing models, theories of persuasion, studies of administrative programs to control prescribing, and sub-optimally designed studies of educational efforts to influence drug prescribing.
Social Science & Medicine (1967)How physicians choose their drugs
49 Citations1976John Lilja
The author described how general practitioners in Sweden make their choice of drugs, with one of the central components being the physician's disposition towards drugs for a specific disease.
Medical CareThe Effect of Computerized Feedback Coupled with a Newsletter upon Outpatient Prescribing Charges
47 Citations1988Charles O. Hershey, Harold I. Goldberg +1 more
PubMedPhysician behavior modification using claims data: tetracycline for upper respiratory infection.
45 Citations1982Thomas S. McConnell, Alice H. Cushing +4 more
Modification of physicians' tetracycline prescribing behavior was achieved in an actual practice setting by personal visits from peer physicians.
JAMAMedical Thinking: The Psychology of Medical Judgment and Decision Making
45 Citations1987William R. Best
There is a wealth of information in this volume on current knowledge about how the authors actually do, or theoretically might, acquire, evaluate, and make decisions to act on patient-related information in the practice of medicine.
Medical CareFailure of Low-cost Audits With Feedback to Reduce Laboratory Test Utilization
44 Citations1987Robert G. Wones
The medical literature contains more than 20 studies of education as a cost-control measure but the unknown mechanism by which these programs achieve their savings is not adequately addressed.
Journal of GerontologyEncouraging Preventive Behavior for Distant and Proximal Health Threats: Effects of Vivid versus Abstract Information
41 Citations1986Karen S. Rook
This study presented vivid versus abstract information about osteoporosis to two audiences who differed in proximity to this threat: premenopausal women versus post menopausal women (distant threat) and the vivid version was perceived by both groups to have had greater behavioral impact.
American Journal of Health-System PharmacyEffect of Clinical Pharmacy Services on Prescribing on an Orthopedic Unit
40 Citations1983Eric T. Herfindal, Linda R. Bernstein +1 more
Prescribing patterns of physicians on a university-hospital orthopedic unit before, during, and after a clinical pharmacist's intervention were monitored and compared with patterns on a similar unit without clinical pharmacy services at another university hospital.
American Journal of Health-System PharmacyEffect of clinical pharmacists on drug prescribing in a primary-care clinic
36 Citations1987Andy Stergachis, M Fors +3 more
In relatively unstructured interactions with physicians and nurses, clinical pharmacists were not able to reduce the costs associated with NSAIDs but did have a modest effect on altering salicylate prescribing patterns.
American Journal of Health-System PharmacyRationales expressed by empiric antibiotic prescribers
30 Citations1982Charles D. Hepler, Kurt E. Clyne +1 more
Medical Decision MakingPremature Conclusions in the Diagnosis of Iron-deficiency Anemia
23 Citations1986Catherine E. DuBeau, Anthony E. Voytovich +1 more
Patients with iron-deficiency anemia were audited using a computer-based algorithm and the diagnostic conclusion seemed unjustified and characteristic of premature closure, one of four recurring errors in diagnostic reasoning described.
Academic MedicineEvaluations of continuing medical education for chronic obstructive pulmonary diseases
20 Citations1979V L Wang, P. B. Terry +4 more
A continuing medical education program which linked primary care physicians to a source of needed appropriate clinical knowledge at a relatively low cost has been demonstrated and indicated significant changes in physician knowledge, judgment, and self-reported behavior related to diagnosis and treatment of chronic obstructive pulmonary disease.
The Journal of Medicine and Philosophy A Forum for Bioethics and Philosophy of MedicineTeaching Clinical Decision Making
19 Citations1984Kenneth R. Howe, Margaret M. Holmes +1 more
A three quarter pre-clinical course was revised to incorporate decision analysis and ethical analysis to address problems of the two-year-old innovation.
Journal of Pharmaceutical Marketing & ManagementPrescribing Intention and the Relative Importance of Drug Attributes
13 Citations1987Vijit Chinburapa, Lon N. Larson +3 more
The Fishbein Model was found to explain a significant portion of the variance in prescribing intentions of the HMO and FFS physicians.
PubMedAntipsychotic drugs: can education change prescribing practices?
11 Citations1979Schroeder Nh, Caffey Em +1 more
The 2 major findings of the study were that there was less polypharmacy--less use of antiparkinson drugs and less use of anti-psychotherapeutic drugs for longer than 6 months--and that there were no statistically significant differences among educational groups.