CHANGING PHYSICIAN PRESCRIBING PATTERNS - EVALUATION OF AN EDUCATIONAL STRATEGY FOR ACUTE DIARRHEA IN MEXICO-CITY

This paper presents the results of an intervention strategy designed t o decrease drug prescription and increase the use of oral rehydration therapy (ORT) in the treatment of acute diarrhea aimed at family medic ine practitioners in two primary health care units of the Mexican Soci al Security Institute. The intervention consisted of six successive st ages: 1) Baseline study of prescribing practices by all 69 physicians in both clinics; 2) Training workshop attended by 36 physicians, inclu ding a critical analysis of relevant up-to-date literature, review of results of stage 1, discussion of a previously designed treatment algo rithm for acute diarrhea, and modification of it according to particip ant's experience; 3) Post-workshop evaluation; 4) Establishment of a p eer review committee to discuss the treatment behavior of participatin g physicians; 5) Mid-term evaluation for 2 months after the committee stopped functioning; 6) Long-term evaluation at 6, 12 and 18 months, o f 20 physicians who received the complete intervention (study group) a nd 20 physicians who received none (control group). The treatment beha viors of the study and control groups were similar on baseline, but di ffered significantly (P<0.01) in the post-workshop evaluation. The stu dy group showed a reduction in the use of antibiotics (from 78.8% to 3 9.3%) and restrictive diets (47.3% to 12.4%), and increased the use of ORT (31.4% to 58.4%) for children younger than 5 years old with acute diarrhea. In the mid-term evaluation, the use of antibiotics by the s tudy group decreased to 27.6%, prescription of restrictive diets decre ased to 6.4%, and use of ORT increased to 73.8% (P<0.01, in all cases) . In the long-term evaluation, persistent positive prescribing behavio r was still present in the study group, with a significant difference (P<0.05) compared to the control group, where no modification was foun d in the prescribing behavior throughout the study. The average propor tion of cases treated according to the algorithm by the study group in creased in 29.2% (31.3 to 60.5%) after the workshop, and 45.2% (31.3 t o 76.5%) after peer review committee. This behavior was maintained dur ing 18 months after the intervention (74%). The control group showed n o significant modification in the average proportion of cases treated according to the algorithm during the study (2 years 7 months). The ac tive participation of physicians in the workshop and in the peer revie w committee was identified as the key to the short and long-term succe ss of the educational strategy.