title: Can rational prescribing be improved by an outcome-based educational approach? A randomized trial completed in Iran.
abstract: BACKGROUND
  An outcome-based education approach has been proposed to develop more effective continuing medical education (CME) programs. We have used this approach in developing an outcome-based educational intervention for general physicians working in primary care (GPs) and evaluated its effectiveness compared with a concurrent CME program in the field of rational prescribing.
  
  
  METHODS
  A cluster randomized controlled design was used. All 159 GPs working in 6 cities, in 2 regions in East Azerbaijan province in Iran, were invited to participate. The cities were matched and randomly divided into an intervention arm, for an outcome-based education on rational prescribing, and a control arm for a traditional CME program on the same topic. GPs' prescribing behavior was assessed 9 months before, and 3 months after the CME programs.
  
  
  RESULTS
  In total, 112 GPs participated. The GPs in the intervention arm significantly reduced the total number of prescribed drugs and the number of injections per prescription. The GPs in the intervention arm also increased their compliance with specific requirements for a correct prescription, such as explanation of specific time and manner of intake and precautions necessary when using drugs, with significant intervention effects of 13, 36, and 42 percentage units, respectively. Compared with the control arm, there was no significant improvement when prescribing antibiotics and anti-inflammatory agents.
  
  
  CONCLUSIONS
  Rational prescribing improved in some of the important outcome-based indicators, but several indicators were still suboptimal. The introduction of an outcome-based approach in CME seems promising when creating programs to improve GPs' prescribing behavior.
authors.affiliation: Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, and Educational Development Center, and National Public Health Management Center, Tabriz University of Medical Sciences, Sweden. Hamideh.Mohammadzadeh@ki.se
authors.forename: Hamideh M
authors.initials: HM
authors.lastname: Esmaily
authors.forename: Ivan
authors.initials: I
authors.lastname: Silver
authors.forename: Shadi
authors.initials: S
authors.lastname: Shiva
authors.forename: Alireza
authors.initials: A
authors.lastname: Gargani
authors.forename: Nasrin
authors.initials: N
authors.lastname: Maleki-Dizaji
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Maniri
authors.forename: Rolf
authors.initials: R
authors.lastname: Wahlstrom
mesh_terms: D016000:Cluster Analysis; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004502:Education, Medical, Continuing / Q000379:methods*; D006801:Humans; D007492:Iran; D017063:Outcome Assessment, Health Care; D010821:Physicians, Family / Q000193:education*; D010818:Practice Patterns, Physicians'