Effectiveness of educational interventions on the improvement of drug prescription in primary care: a critical literature review

This paper is a critical review of studies of educational programmes design ed to improve prescription practices in ambulatory care. Scientific article s were selected from the following bibliographical indices: MEDLINE, IME, I CYT and ERIC. The searches covered the time period between 1988 and 1997. T he search criteria included: primary-care, educat*, prescription* and other related keywords. The inclusion criteria were studies describing education al strategies aimed at general practitioners working in ambulatory settings . The study outcome was change in pre scribing behaviour of physicians thro ugh prescribing indicators. The following data were extracted: study design , target drugs, type of intervention, follow-up period of the prescription trends, type of data analysis, type of statistical analysis and reported re sults. We found 3233 articles that met the search criteria. Of these, 51 me t the inclusion criteria and 43 studied the efficacy/effectiveness of one o r various interventions as compared to no intervention. Among seven studies evaluating active strategies, four reported positive results (57%), as opp osed to three of the eight studies assessing passive strategies (38%). Amon g the 28 studies that tested reinforced active strategies, 16 reported posi tive results for all variables (57%). Eight studies were classified as a hi gh degree of evidence (16%). We concluded that the results of our review su ggest that the more personalized, the more effective the strategies are. We observe that combining active and passive strategies results in a decrease of the failure rate. Finally, better studies are still needed to enhance t he efficacy and efficiency of prescribing practices.