Impact of case scenarios in an educational program to change drug prescribing in a health maintenance organization.

Persistent Link:
http://hdl.handle.net/10150/184600
Title:
Impact of case scenarios in an educational program to change drug prescribing in a health maintenance organization.
Author:
Raisch, Dennis William.
Issue Date:
1988
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
This dissertation evaluated the provision of two different one-to-one educational interventions, randomly assigned, to two separate groups of medical practitioners at a health maintenance organization (HMO), Cigna Healthplan of Tucson, Arizona. A control group received no intervention. Each group consisted of seven physicians and one nurse practitioner. The intervention was aimed at improving the prescribing of the anti-ulcer drugs, cimetidine, ranitidine, and sucralfate. The theoretical basis for the study involved the cognitive principle of vividness, which implies that more vivid information has greater effect on decisions. For this research, the vivid intervention included case scenarios, while the non-vivid intervention included statistical information of the results of a drug use review. Prescribing data, consisting of percentages and cost of inappropriate prescriptions, were collected for one month prior to and for two months after the intervention. Analysis of covariance was employed with the pre-intervention measures of prescribing as the covariate in each test and post-intervention measures as the dependent variables. No differences were found between the two interventions, but the control group was significantly different from the intervention groups. For the first post-intervention month, it was found that the interventions resulted in significantly lower percentages of prescriptions written inappropriately for indication, dose, or duration (P = 0.001). These percentages decreased by 36% for the intervention groups, while increasing by 14% for the control group. Costs of inappropriate prescribing per study prescription and per patient encounter were also significantly lower for the intervention groups than for the control group (P = 0.001 and P = 0.019, respectively). In the second post-intervention month, inappropriate prescribing increased slightly in the intervention groups and were no longer significantly different from the control group. The research demonstrated the effectiveness of a one-to-one educational intervention in improving drug prescribing at an HMO. The lack of differences between the two interventions may have been due to the overall effectiveness of the one-to-one educational discussion, the interpretation of the statistical information as prescribing feedback by the practitioners, or the inadequate presentation of vividness in the case scenarios.
Type:
text; Dissertation-Reproduction (electronic)
Keywords:
Physicians -- In-service training.; Nurse practitioners -- In-service training.; Medicine -- Study and teaching (Continuing education); Drugs -- Prescribing.
Degree Name:
Ph.D.
Degree Level:
doctoral
Degree Program:
Pharmacy Practice; Graduate College
Degree Grantor:
University of Arizona
Advisor:
Bootman, Lyle

Full metadata record

DC FieldValue Language
dc.language.isoenen_US
dc.titleImpact of case scenarios in an educational program to change drug prescribing in a health maintenance organization.en_US
dc.creatorRaisch, Dennis William.en_US
dc.contributor.authorRaisch, Dennis William.en_US
dc.date.issued1988en_US
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractThis dissertation evaluated the provision of two different one-to-one educational interventions, randomly assigned, to two separate groups of medical practitioners at a health maintenance organization (HMO), Cigna Healthplan of Tucson, Arizona. A control group received no intervention. Each group consisted of seven physicians and one nurse practitioner. The intervention was aimed at improving the prescribing of the anti-ulcer drugs, cimetidine, ranitidine, and sucralfate. The theoretical basis for the study involved the cognitive principle of vividness, which implies that more vivid information has greater effect on decisions. For this research, the vivid intervention included case scenarios, while the non-vivid intervention included statistical information of the results of a drug use review. Prescribing data, consisting of percentages and cost of inappropriate prescriptions, were collected for one month prior to and for two months after the intervention. Analysis of covariance was employed with the pre-intervention measures of prescribing as the covariate in each test and post-intervention measures as the dependent variables. No differences were found between the two interventions, but the control group was significantly different from the intervention groups. For the first post-intervention month, it was found that the interventions resulted in significantly lower percentages of prescriptions written inappropriately for indication, dose, or duration (P = 0.001). These percentages decreased by 36% for the intervention groups, while increasing by 14% for the control group. Costs of inappropriate prescribing per study prescription and per patient encounter were also significantly lower for the intervention groups than for the control group (P = 0.001 and P = 0.019, respectively). In the second post-intervention month, inappropriate prescribing increased slightly in the intervention groups and were no longer significantly different from the control group. The research demonstrated the effectiveness of a one-to-one educational intervention in improving drug prescribing at an HMO. The lack of differences between the two interventions may have been due to the overall effectiveness of the one-to-one educational discussion, the interpretation of the statistical information as prescribing feedback by the practitioners, or the inadequate presentation of vividness in the case scenarios.en_US
dc.typetexten_US
dc.typeDissertation-Reproduction (electronic)en_US
dc.subjectPhysicians -- In-service training.en_US
dc.subjectNurse practitioners -- In-service training.en_US
dc.subjectMedicine -- Study and teaching (Continuing education)en_US
dc.subjectDrugs -- Prescribing.en_US
thesis.degree.namePh.D.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplinePharmacy Practiceen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorBootman, Lyleen_US
dc.contributor.committeememberMcGhan, William F.en_US
dc.contributor.committeememberLarson, Lon N.en_US
dc.contributor.committeememberWholey, Douglas R.en_US
dc.contributor.committeememberWagner, W. Garyen_US
dc.identifier.proquest8907411en_US
dc.identifier.oclc701904210en_US
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