title: Reducing the prescribing of heavily marketed medications: a randomized controlled trial.
abstract: BACKGROUND
  Prescription drug costs are a major component of health care expenditures, yet resources to support evidence-based prescribing are not widely available.
  
  
  OBJECTIVE
  To evaluate the effectiveness of computerized prescribing alerts, with or without physician-led group educational sessions, to reduce the prescribing of heavily marketed hypnotic medications.
  
  
  METHODS
  Cluster-randomized controlled trial.
  
  
  METHODS
  We randomly allocated 14 internal medicine practice sites to receive usual care, computerized prescribing alerts alone, or alerts plus group educational sessions.
  
  
  METHODS
  Proportion of heavily marketed hypnotics prescribed before and after the implementation of computerized alerts and educational sessions.
  
  
  RESULTS
  The activation of computerized alerts held the prescribing of heavily marketed hypnotic medications at pre-intervention levels in both the alert-only group (adjusted risk ratio [RR] 0.97; 95% CI 0.82-1.14) and the alert-plus-education group (RR 0.98; 95% CI 0.83-1.17) while the usual-care group experienced an increase in prescribing (RR 1.31; 95% CI 1.08-1.60). Compared to the usual-care group, the relative risk of prescribing heavily marketed medications was less in both the alert-group (Ratio of risk ratios [RRR] 0.74; 95% CI 0.57-0.96) and the alert-plus-education group (RRR 0.74; 95% CI 0.58-0.97). The prescribing of heavily marketed medications was similar in the alert-group and alert-plus-education group (RRR 1.02; 95% CI 0.80-1.29). Most clinicians reported that the alerts provided useful prescribing information (88%) and did not interfere with daily workflow (70%).
  
  
  CONCLUSIONS
  Computerized decision support is an effective tool to reduce the prescribing of heavily marketed hypnotic medications in ambulatory care settings.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00788346.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA. rfortuna@post.harvard.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fortuna
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
authors.forename: Francis X
authors.initials: FX
authors.lastname: Campion
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
authors.forename: Jamie B
authors.initials: JB
authors.lastname: Kotch
authors.forename: Adrianne C
authors.initials: AC
authors.lastname: Feldstein
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simon
mesh_terms: D020000:Decision Support Systems, Clinical / Q000592:standards; D004345:Drug Industry / Q000379:methods / Q000592:standards; D011307:Drug Prescriptions / Q000592:standards*; D055695:Electronic Prescribing / Q000592:standards*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007388:Internal Medicine / Q000379:methods / Q000592:standards; D008297:Male; D040541:Marketing / Q000379:methods / Q000592:standards*; D016347:Medical Records Systems, Computerized / Q000592:standards*; D008875:Middle Aged; D010820:Physicians / Q000592:standards; D055553:Prescription Drugs / Q000627:therapeutic use*; D011364:Professional Practice / Q000592:standards
chemical_list: D006993:Hypnotics and Sedatives; D055553:Prescription Drugs