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Ingrid S Sketris
Ethel M Langille Ingram
Heather L Lummis


Prescribing behaviour, drug utilization, prescribing practice, medication management, drug use evaluation



Canadians receive over 422 million prescriptions and spend over $26 billion annually on drugs. Yet, we do not systematically  capture information  on whether  the right drugs reach the right people with the intended benefits, while avoiding unintended harm. It is important to identify and understand the effectiveness of approaches used to improve prescribing and medication use.


To discuss the medication-use system, identify factors affecting prescribing, and assess effectiveness of interventions.


A  literature  review  was  conducted  using  electronic  databases,  federal  agencies’,  provincial  health departments’,   health  service   delivery  organizations’   and  Canadian   health  research   organizations’ websites , the Internet, and some hand searching. Interventions identified were categorized according to the Effective Practice and Organization of Care Group (EPOC) classification, with effectiveness based on the literature.


Factors   affecting   prescribing   relate   to   the   patient   and   society,   medication,   prescriber,   practice environment and organization, available information and other external factors. Interventions reported as generally  effective  are  multi-faceted  interventions,  academic  detailing,  and  reminders.  Interventions reported as sometimes effective are audit and feedback or physician profiling, local opinion leaders, drug utilization  review,  and  local  consensus  guidelines.  Passive  dissemination  of  educational  materials  is deemed generally ineffective.


No single approach is appropriate for every prescribing problem, health professional prescriber practice or health care setting.  Interventions  to improve  prescribing  in community and institutional  settings have variable effect sizes. Effectiveness  is related to content, delivery mechanisms,  intensity,  intervention’s context, and implementation  environment.  Even an intervention with a small effect size (< 10%) may yield important changes in drug use when applied on a population basis. Further research and evaluation is  needed  to  determine   how  or  why  the  interventions   work  and  identify  barriers  to  effective implementation.

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