EVALUATION OF AN INTERVENTION TO CHANGE BENZODIAZEPINE-PRESCRIBING BEHAVIOR IN A PREPAID GROUP-PRACTICE SETTING

To determine the effect of two levels of educational intervention on b enzodiazepine-prescribing behavior in an elderly population in a contr olled prepaid group practice (PPGP) setting, we designed a prospective controlled trial, with six-month followup. Our setting was a 270,000 member group-model PPGP in Colorado, from 1990 to 1991. Participants i ncluded 91 physicians, 62 men and 29 women; median age was 38.7 years. Group 1 received a one-on-one educational presentation by a clinical pharmacist, written educational materials, a brief follow-up visit, an d feedback with recommendations. Group 2 received only a face-to-face presentation, given to departmental groups, as well as the same writte n educational materials used in group 1. Controls received no interven tion. Our primary outcome measure was the benzodiazepine ''on/off'' st atus of the elderly PPGP members. The secondary outcome measure was th e median change (preintervention minus postintervention) in a standard ized amount of benzodiazepines prescribed per physician. Logistic regr ession analysis failed to show a significant effect on postinterventio n benzodiazepine on/off status between study groups, when controlling for preintervention on/off status, PPGP-member age, PPGP-member gender , and all possible interactions. Analysis of variance failed to demons trate an effect of either intervention on the median change in standar dized amount of benzodiazepines prescribed per physician, with groups 1, 2, and controls yielding values of -278 (range: -4,137, 2,844), -33 0 (-1,531, 1,358), and -541 (range: -3,716, 2,185), respectively. We c onclude that strategies effective in changing physician prescribing be havior in other settings may not be effective in a PPGP setting with b enzodiazepines in the elderly as the target for change.