THE IMPACT OF A DRUG UTILIZATION REVIEW PROGRAM AS A CHANGE AGENT ON PHYSICIAN PRESCRIBING BEHAVIOR FOLLOWING THE PUBLICATION OF A RANDOMIZED CLINICAL TRIAL.

摘要

Literature shows that physicians' prescribing behavior is often discordant with randomized clinical trial (RCT) results. Part of the problem may be due to a failure in the diffusion of innovation.; This experimental study tested the impact of the Minnesota Department of Human Services Drug Utilization Review (DUR) Program as a change agent on physician adoption of a selected RCT (N Engl J Med 1986;314:1547-52). An experimental group of Minnesota Medicaid physicians (n = 288) was sent a packet three months after the RCT was published. The packet consisted of a letter from the DUR Coordinator, the journal article reprint, and a drug history profile of a patient who might benefit from the information. A control group (n = 288) received no intervention.; Descriptive analysis showed that two-thirds of the physicians were previously aware of the RCT. Over one-half of them indicated awareness from the medical journal. Almost all of the Internists and less than two-thirds of the Family Practitioners were previously aware. The majority of the patients were being treated by Family Practitioners.; Factors significantly associated with the physician's intent to adopt related to their training, experience, peer comments, new drug availability, and the size of the mortality reduction of the study drugs. Only the latter factor was associated with the RCT itself.; It was hypothesized that those physicians receiving a change agent intervention would be more innovative (i.e. earlier in adopting) than those not receiving an intervention. At the end of four months, the hypothesis was tested using nonparametric "survival" analysis techniques which compared two time-to-event (prescription change) distributions. The data did not support the hypothesis. The message may have been more important than the change agent in the DUR Program's lack of effectiveness. Changing prescribing behavior following the publication of RCTs remains a problem in the diffusion of innovation. The lack of effectiveness of the DUR Program in this setting should not be construed as an overall lack of Program effectiveness, but rather as an invitation for further evaluation and research of the Program in its more traditional environment.