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This study reviewed published studies on interventions used by hospitals, health insurance programs, or governments to improve use of medicines in foreign countries. Interventions to improve use of medicines are classified into two categories: 1) information strategies-dissemination of educational materials, group education, one-to-one educational outreach, drug utilization review, and feedback; 2) managerial strategies- formularies, prior authorization, and financial incentives. Dissemination of educational materials, which is a common intervention, was unsuccessful in changing physicians' prescribing behaviors. Problem-based small group education was more likely to change behaviors than didactic large group education. One-to-one educational outreach(academic detailing) was among the most effective strategies used to change prescribing behaviors. Prospective drug utilization review (DUR) program was more successful in improving use of medicines than retrospective DUR program. Feedback intervention has been reported to be ineffective to change behaviors. Formularies are frequently used to control medication use by most health insurance programs. Financial incentives provide physicians economic incentives according to appropriateness of prescribing. However, few published studies have assessed the efficacy of formularies or financial incentives. Prior authorization requires physicians to get authorization from health insurers before prescribing a certain group of drugs which is usually of high costs or risk. There is no magic bullet for quality use of medicines. Multifaceted interventions that help to predispose, enable, and reinforce desired behaviors are more likely to be successful. |
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