USE OF PHYSICIAN PROFILES TO INFLUENCE PRESCRIBING OF TOPICAL CORTICOSTEROIDS
Main Article Content
Keywords
Topical corticosteroids, physician prescribing profiles, drug utilization
Abstract
Background
Physician profiling is a tool used to attempt to affect changes in prescribing. The Drug Evaluation Alliance of Nova Scotia (DEANS) decided to implement a physician profiling project to determine if prescribing of topical corticosteroids could be altered.
Objectives
To evaluate a DEANS initiative utilizing physician prescribing profiles to shift prescribing of topical corticosteroids from higher to lower potency agents in beneficiaries of the Nova Scotia Seniors’ Pharmacare Program.
Methods
Administrative claims from the Nova Scotia Seniors’ Pharmacare program were used to identify prescriptions for topical corticosteroids. Prescriptions were summarized at the individual physician level, and aggregated by Anatomical Therapeutic Classification into weak, moderately potent, potent and very potent products. The number of prescriptions for topical corticosteroids was compared for the twelve- month period before and after mailing of the profiles. Overall results were aggregated by utilization and expenditures.
Results
The number of prescriptions for topical corticosteroids per physician profiled was 44.0 in 2000/2001 and 42.8 in 2001/2002 (p=NS) and the expenditures per physician profiled were $838.94 in 2000/2001 and $826.81 in 2001/2002 (p=NS). There was a small decrease in prescriptions dispensed for potent topical products over the profiling period (52.4% of prescriptions in 2000/2001 versus 51.5% of prescriptions in 2001/2002, p=0.03). Otherwise, changes in utilization or expenditures for topical corticosteroids were not statistically different between the profiling periods.
Conclusions
This project showed that mailing unsolicited individual-level profiles did not alter prescribing or expenditures for topical corticosteroids over a two-year period. Further work is needed to determine physician attitudes towards such projects.
References
1. Grimshaw JM, Shirran L, Thomas R et al. Changing provider behavior: an overview of systematic reviews of interventions. Med Care 2001 Aug;39(8 Suppl
2):II2-45.
2. Grimshaw JM, Eccles MP, Walker AE, Thomas RE. Changing physicians' behavior: what works and thoughts on getting more things to work. J Contin Educ Health Prof 2002;22:237-43.
3. Oxman AD, Thomson MA, Davis DA, Haynes RB.No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ
1995;53:1423-31.
4. Wennberg DE. Variation in the delivery of health care: the stakes are high. Ann Intern Med 1998;128:866-8.
5. Greco PJ, Eisenberg JM. Changing physicians' practices. N Engl J Med 1993;329:1271-3.
6. Rogers EM. Lessons for guidelines from the diffusion of innovations. Jt Comm J Qual Improv 1995;21:324-8.
7. Freemantle N, Eastaugh J. Using effectiveness studies for prescribing research, part 1. J Clin Pharm Ther 2002;27:383-9.
8. Grol R. Changing physicians' competence and performance: finding the balance between the individual and the organization. J Contin Educ Health Prof 2002;22:244-51.
9. Soumerai SB, Ross-Degnan D, Fortess EE, Abelson J. A critical analysis of studies of states drug reimbursement policies: research in need of discipline. Milbank Q 1993;71:217-52.
10. Institute of Medicine. Committee on Identifying Priority Areas for Quality Improvement. Karen Adams and Janet M. Corrigan, ed. Priority Areas for National Action: Transforming Health Care Quality. (2003) http://www.nap.edu/books/0309085438/html/ (accessed May 12, 2004).
11. Bindman AB. Can physician profiles be trusted? JAMA 1999;281:2142-3.
12. Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ
1998;317:465-8.
13. Weiss KB, Wagner R. Performance measurement through audit, feedback, and profiling as tools for improving clinical care. Chest 2000;118(suppl 2):S53-8.
14. Foy R, MacLennan G, Grimshaw J, Penney G, Campbell M, Grol R. Attributes of clinical recommendations that influence change in practice following audit and feedback. J Clin Epidemiol 2002;55:717-22.
15. Grol R. Personal paper. Beliefs and evidence in changing clinical practice. BMJ 1997;315:418-21.
16. Johnston G, Crombie IK, Davies HT, Alder EM, Millard A. Reviewing audit: barriers and facilitating factors for effective clinical audit. Qual Health Care
2000;91:23-36.
17. Kassirer JP. The use and abuse of practice profiles. N Engl J Med 1994;330:634-6.
18. Carter AO, Strachan D, Appiah Y. Physician prescribing practices: What do we know? Where do we go? How do we get there? CMAJ 1996;154:1649-53.
19. Bloor K, Freemantle N. Lessons from international experience in controlling pharmaceutical expenditure. II: Influencing doctors. BMJ 1996;312:1525-7.
20. Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA 1995;274:700-5.
21. Smith WR. Evidence for the effectiveness of techniques to change physician behavior. Chest 2000;118(suppl 2):S8-17.
22. MacKinnon NJ, Lipowski EE. Opinions on provider profiling: telephone survey of stakeholders. Am J Health Syst Pharm 2000;57:1585-91.
23. Jamtvedt G, Young JM, Kristoffersen DT, Thomson O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes
(Cochrane Review). In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
24. Stern RS. The pattern of topical corticosteroid prescribing in the United States, 1989-1991. J Am Acad Dermatol 1996;35(2Pt1):183-6.
25. Campbell CA, Cooke CA, Weerasinghe SD, Sketris IS, McLean-Veysey PR, Skedgel CD. Topical corticosteroid prescribing patterns following changes in drug benefit status. Ann Pharmacother 2003;37:787-93.
26. Boguniewicz M, Eichenfield LF, Hultsch T. Current management of atopic dermatitis and interruption of the atopic march. J Allergy Clin Immunol 2003;
112(suppl 6):S140-50.
27. World Health Organization Collaborating Centre for Drug Statistics Methodology. ATC Index with DDDs, 2002. Oslo, Norway: World Health Organization,
2002.
28. Atherton DJ. Topical corticosteroids in atopic dermatitis. BMJ 2003;327:942-3.
29. Marek-Thompson TA, Bond CA. Dermatotherapy. In: Young LY, Koda-Kimble MA, eds. Applied Therapeutics: the clinical use of drugs. 7th ed. Vancouver, WA: Applied Therapeutics Inc, 2001:10-3.
30. Drugdex® Editorial Staff. Topical corticosteroids - dosing guidelines (Drug Consult). In: Hutchison TA & Shahan DR, eds. DRUGDEX® System. Greenwood Village, CO: MICROMEDEX, (Edition expires [06/2004]).
31. Lester RS. Atopic dermatitis. In: Gray J, ed. Therapeutic Choices. 4th ed. Ottawa: Canadian Pharmacists Association, 2003:706-711.
32. Zug KA, McKay M. Eczematous dermatitis: a practical review. Am Fam Physician 1996;54:1243-50.
33. Atopic dermatitis. In: Herfindal ET, Gourley DRH, eds. Textbook of therapeutics: drug and disease management. Philadelphia: Lippincott, Williams &
Wilkins, 2000:976-983.
34. Nova Scotia Department of Health. Drug Evaluation Alliance of Nova Scotia (DEANS). http://www.gov.ns.ca/heal/pharmacare/deans.htm (accessed on 12 January 2005).
35. Population Health Research Unit (PHRU), Dalhousie University. http://phru.medicine.dal.ca/ (accessed on 12 January 2005).
36. Health Canada. Drug Product Database. http://www.hc-sc.gc.ca/hpfb-dgpsa/tpd- dpt/index_drugs_dpd_e.html (accessed on 12 January 2005).
37. Department of Pharmaceutical Services. Nova Scotia Formulary. Halifax, NS: Nova Scotia Department of Health, 1999, 2000, 2001.
38. Gillis MC. Compendium of Pharmaceuticals and Specialties. 36th edition. Ottawa: Canadian Pharmaceutical Association, 2001.
39. Dalhousie University Faculty of Medicine. Department of Continuing Medical Education. http://cme.medicine.dal.ca/ (accessed May 12, 2004).
40. Pharmacy Association of Nova Scotia. DEANS Launches an Initiative to Encourage Appropriate Prescribing of Topical Corticosteroids. The
Pharmacist 2001;4(1):4.
41. Nova Scotia Pharmacare Program. Topical Corticosteroid Cost Comparison Chart. Pharmacists’ Bulletin 2001; 01(9):2-3.
42. Patented Medicine Prices Review Board. A Description of the Laspeyres Methodology used to Construct the Patented Medicine Price Index (PMPI). Report #S9710. Patented Medicines Prices Review Board: Toronto, June 2000.
43. Getzen TE. Medical care price indexes: theory, construction & empirical analysis of the US series 1927-1990. Adv Health Econ Health Serv Res 1992;13:83-128.
44. Danzon PM, Chao LW. Cross-national price differences for pharmaceuticals: how large, and why? J Health Econ 2000;19:159-95.
45. SAS 8.1 for Open VMS 7.2-1. Version 8.1. Cary, North Carolina: SAS Institute Inc., 2000.
46. Canadian Institute of Health Information (CIHI). http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=st atistics_results_topic_physicians_e&cw_topic=Health
%20Human%20Resources&cw_subtopic=Physicians (accessed on 12 January 2005).
47. Rokstad K, Straand J, Fugelli P. Can drug treatment be improved by feedback on prescribing profiles combined with therapeutic recommendations? A prospective, controlled trial in general practice. J Clin Epidemiol 1995;48:1061-8.
48. Anderson JF, McEwan KL, Hrudey WP. Effectiveness of notification and group education in modifying prescribing of regulated analgesics. CMAJ
1996;154:31-9.
49. Smith DH, Christensen DB, Stergachis A, Holmes G.
A randomized controlled trial of a drug use review intervention for sedative hypnotic medications. Med Care 1998; 36:1013-21.
50. Hux JE, Melady MP, DeBoer D. Confidential prescriber feedback and education to improve antibiotic use in primary care: a controlled trial. CMAJ 1999;161:388-92.
51. O'Connell DL, Henry D, Tomlins R. Randomised controlled trial of effect of feedback on general practitioners' prescribing in Australia. BMJ 1999;318:507-11.
52. Sondergaard J, Andersen M, Vach K, Kragstrup J, Maclure M, Gram LF. Detailed postal feedback about prescribing to asthma patients combined with a guideline statement showed no impact: a randomised controlled trial. Eur J Clin Pharmacol 2002;58:127-32.
53. Sondergaard J, Andersen M, Stovring H, Kragstrup J. Mailed prescriber feedback in addition to a clinical guideline has no impact: a randomised, controlled trial. Scand J Prim Health Care 2003;21:47-51.
54. Pimlott NJ, Hux JE, Wilson LM, Kahan M, Li C, Rosser WW. Educating physicians to reduce benzodiazepine use by elderly patients: a randomized controlled trial. CMAJ 2003;168:835-9.
55. Walker AE, Grimshaw J, Johnston M, Pitts N, Steen N, Eccles M. PRIME--PRocess modelling in ImpleMEntation research: selecting a theoretical basis for interventions to change clinical practice. BMC Health Serv Res 2003;3:22.
56. Sketris IS, Kephart GC, Frail DM, Skedgel C, Allen MJ. The effect of deinsuring chlorpropamide on the prescribing of oral antihyperglycemics for Nova
Scotia Seniors' Pharmacare beneficiaries. Pharmacotherapy. 2004 Jun;24(6):784-91.
57. Grimshaw J, McAuley LM, Bero LA, et al. Systematic reviews of the effectiveness of quality improvement strategies and programmes. Qual Saf
Health Care 2003;12:298-303.
58. Tamblyn R, Lavoie G, Petrella L, Monette J. The use of prescription claims databases in pharmacoepidemiological research: the accuracy and comprehensiveness of the prescription claims database in Quebec. J Clin Epidemiol 1994;48:999-1009.
59. Levy AR, O’Brien BJ, Sellors C, Grootendorst P, Willison D. Coding accuracy of administrative drug claims in the Ontario Drug Benefit database. Can J Clin Pharmacol 2003;10:67-71.
2):II2-45.
2. Grimshaw JM, Eccles MP, Walker AE, Thomas RE. Changing physicians' behavior: what works and thoughts on getting more things to work. J Contin Educ Health Prof 2002;22:237-43.
3. Oxman AD, Thomson MA, Davis DA, Haynes RB.No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ
1995;53:1423-31.
4. Wennberg DE. Variation in the delivery of health care: the stakes are high. Ann Intern Med 1998;128:866-8.
5. Greco PJ, Eisenberg JM. Changing physicians' practices. N Engl J Med 1993;329:1271-3.
6. Rogers EM. Lessons for guidelines from the diffusion of innovations. Jt Comm J Qual Improv 1995;21:324-8.
7. Freemantle N, Eastaugh J. Using effectiveness studies for prescribing research, part 1. J Clin Pharm Ther 2002;27:383-9.
8. Grol R. Changing physicians' competence and performance: finding the balance between the individual and the organization. J Contin Educ Health Prof 2002;22:244-51.
9. Soumerai SB, Ross-Degnan D, Fortess EE, Abelson J. A critical analysis of studies of states drug reimbursement policies: research in need of discipline. Milbank Q 1993;71:217-52.
10. Institute of Medicine. Committee on Identifying Priority Areas for Quality Improvement. Karen Adams and Janet M. Corrigan, ed. Priority Areas for National Action: Transforming Health Care Quality. (2003) http://www.nap.edu/books/0309085438/html/ (accessed May 12, 2004).
11. Bindman AB. Can physician profiles be trusted? JAMA 1999;281:2142-3.
12. Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ
1998;317:465-8.
13. Weiss KB, Wagner R. Performance measurement through audit, feedback, and profiling as tools for improving clinical care. Chest 2000;118(suppl 2):S53-8.
14. Foy R, MacLennan G, Grimshaw J, Penney G, Campbell M, Grol R. Attributes of clinical recommendations that influence change in practice following audit and feedback. J Clin Epidemiol 2002;55:717-22.
15. Grol R. Personal paper. Beliefs and evidence in changing clinical practice. BMJ 1997;315:418-21.
16. Johnston G, Crombie IK, Davies HT, Alder EM, Millard A. Reviewing audit: barriers and facilitating factors for effective clinical audit. Qual Health Care
2000;91:23-36.
17. Kassirer JP. The use and abuse of practice profiles. N Engl J Med 1994;330:634-6.
18. Carter AO, Strachan D, Appiah Y. Physician prescribing practices: What do we know? Where do we go? How do we get there? CMAJ 1996;154:1649-53.
19. Bloor K, Freemantle N. Lessons from international experience in controlling pharmaceutical expenditure. II: Influencing doctors. BMJ 1996;312:1525-7.
20. Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA 1995;274:700-5.
21. Smith WR. Evidence for the effectiveness of techniques to change physician behavior. Chest 2000;118(suppl 2):S8-17.
22. MacKinnon NJ, Lipowski EE. Opinions on provider profiling: telephone survey of stakeholders. Am J Health Syst Pharm 2000;57:1585-91.
23. Jamtvedt G, Young JM, Kristoffersen DT, Thomson O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes
(Cochrane Review). In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
24. Stern RS. The pattern of topical corticosteroid prescribing in the United States, 1989-1991. J Am Acad Dermatol 1996;35(2Pt1):183-6.
25. Campbell CA, Cooke CA, Weerasinghe SD, Sketris IS, McLean-Veysey PR, Skedgel CD. Topical corticosteroid prescribing patterns following changes in drug benefit status. Ann Pharmacother 2003;37:787-93.
26. Boguniewicz M, Eichenfield LF, Hultsch T. Current management of atopic dermatitis and interruption of the atopic march. J Allergy Clin Immunol 2003;
112(suppl 6):S140-50.
27. World Health Organization Collaborating Centre for Drug Statistics Methodology. ATC Index with DDDs, 2002. Oslo, Norway: World Health Organization,
2002.
28. Atherton DJ. Topical corticosteroids in atopic dermatitis. BMJ 2003;327:942-3.
29. Marek-Thompson TA, Bond CA. Dermatotherapy. In: Young LY, Koda-Kimble MA, eds. Applied Therapeutics: the clinical use of drugs. 7th ed. Vancouver, WA: Applied Therapeutics Inc, 2001:10-3.
30. Drugdex® Editorial Staff. Topical corticosteroids - dosing guidelines (Drug Consult). In: Hutchison TA & Shahan DR, eds. DRUGDEX® System. Greenwood Village, CO: MICROMEDEX, (Edition expires [06/2004]).
31. Lester RS. Atopic dermatitis. In: Gray J, ed. Therapeutic Choices. 4th ed. Ottawa: Canadian Pharmacists Association, 2003:706-711.
32. Zug KA, McKay M. Eczematous dermatitis: a practical review. Am Fam Physician 1996;54:1243-50.
33. Atopic dermatitis. In: Herfindal ET, Gourley DRH, eds. Textbook of therapeutics: drug and disease management. Philadelphia: Lippincott, Williams &
Wilkins, 2000:976-983.
34. Nova Scotia Department of Health. Drug Evaluation Alliance of Nova Scotia (DEANS). http://www.gov.ns.ca/heal/pharmacare/deans.htm (accessed on 12 January 2005).
35. Population Health Research Unit (PHRU), Dalhousie University. http://phru.medicine.dal.ca/ (accessed on 12 January 2005).
36. Health Canada. Drug Product Database. http://www.hc-sc.gc.ca/hpfb-dgpsa/tpd- dpt/index_drugs_dpd_e.html (accessed on 12 January 2005).
37. Department of Pharmaceutical Services. Nova Scotia Formulary. Halifax, NS: Nova Scotia Department of Health, 1999, 2000, 2001.
38. Gillis MC. Compendium of Pharmaceuticals and Specialties. 36th edition. Ottawa: Canadian Pharmaceutical Association, 2001.
39. Dalhousie University Faculty of Medicine. Department of Continuing Medical Education. http://cme.medicine.dal.ca/ (accessed May 12, 2004).
40. Pharmacy Association of Nova Scotia. DEANS Launches an Initiative to Encourage Appropriate Prescribing of Topical Corticosteroids. The
Pharmacist 2001;4(1):4.
41. Nova Scotia Pharmacare Program. Topical Corticosteroid Cost Comparison Chart. Pharmacists’ Bulletin 2001; 01(9):2-3.
42. Patented Medicine Prices Review Board. A Description of the Laspeyres Methodology used to Construct the Patented Medicine Price Index (PMPI). Report #S9710. Patented Medicines Prices Review Board: Toronto, June 2000.
43. Getzen TE. Medical care price indexes: theory, construction & empirical analysis of the US series 1927-1990. Adv Health Econ Health Serv Res 1992;13:83-128.
44. Danzon PM, Chao LW. Cross-national price differences for pharmaceuticals: how large, and why? J Health Econ 2000;19:159-95.
45. SAS 8.1 for Open VMS 7.2-1. Version 8.1. Cary, North Carolina: SAS Institute Inc., 2000.
46. Canadian Institute of Health Information (CIHI). http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=st atistics_results_topic_physicians_e&cw_topic=Health
%20Human%20Resources&cw_subtopic=Physicians (accessed on 12 January 2005).
47. Rokstad K, Straand J, Fugelli P. Can drug treatment be improved by feedback on prescribing profiles combined with therapeutic recommendations? A prospective, controlled trial in general practice. J Clin Epidemiol 1995;48:1061-8.
48. Anderson JF, McEwan KL, Hrudey WP. Effectiveness of notification and group education in modifying prescribing of regulated analgesics. CMAJ
1996;154:31-9.
49. Smith DH, Christensen DB, Stergachis A, Holmes G.
A randomized controlled trial of a drug use review intervention for sedative hypnotic medications. Med Care 1998; 36:1013-21.
50. Hux JE, Melady MP, DeBoer D. Confidential prescriber feedback and education to improve antibiotic use in primary care: a controlled trial. CMAJ 1999;161:388-92.
51. O'Connell DL, Henry D, Tomlins R. Randomised controlled trial of effect of feedback on general practitioners' prescribing in Australia. BMJ 1999;318:507-11.
52. Sondergaard J, Andersen M, Vach K, Kragstrup J, Maclure M, Gram LF. Detailed postal feedback about prescribing to asthma patients combined with a guideline statement showed no impact: a randomised controlled trial. Eur J Clin Pharmacol 2002;58:127-32.
53. Sondergaard J, Andersen M, Stovring H, Kragstrup J. Mailed prescriber feedback in addition to a clinical guideline has no impact: a randomised, controlled trial. Scand J Prim Health Care 2003;21:47-51.
54. Pimlott NJ, Hux JE, Wilson LM, Kahan M, Li C, Rosser WW. Educating physicians to reduce benzodiazepine use by elderly patients: a randomized controlled trial. CMAJ 2003;168:835-9.
55. Walker AE, Grimshaw J, Johnston M, Pitts N, Steen N, Eccles M. PRIME--PRocess modelling in ImpleMEntation research: selecting a theoretical basis for interventions to change clinical practice. BMC Health Serv Res 2003;3:22.
56. Sketris IS, Kephart GC, Frail DM, Skedgel C, Allen MJ. The effect of deinsuring chlorpropamide on the prescribing of oral antihyperglycemics for Nova
Scotia Seniors' Pharmacare beneficiaries. Pharmacotherapy. 2004 Jun;24(6):784-91.
57. Grimshaw J, McAuley LM, Bero LA, et al. Systematic reviews of the effectiveness of quality improvement strategies and programmes. Qual Saf
Health Care 2003;12:298-303.
58. Tamblyn R, Lavoie G, Petrella L, Monette J. The use of prescription claims databases in pharmacoepidemiological research: the accuracy and comprehensiveness of the prescription claims database in Quebec. J Clin Epidemiol 1994;48:999-1009.
59. Levy AR, O’Brien BJ, Sellors C, Grootendorst P, Willison D. Coding accuracy of administrative drug claims in the Ontario Drug Benefit database. Can J Clin Pharmacol 2003;10:67-71.
Article Sidebar
Published
Dec 8, 2018
Article Details
How to Cite
S Sketris, I., Kephart, G., A Cooke, C. A. C., D Skedgel, C. D. S., & McLean-Veysey, P. R. (2018). USE OF PHYSICIAN PROFILES TO INFLUENCE PRESCRIBING OF TOPICAL CORTICOSTEROIDS. Journal of Population Therapeutics and Clinical Pharmacology, 12(2). Retrieved from https://jptcp.com/index.php/jptcp/article/view/92
Issue
Section
Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.