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Modifying provider behavior

A low-tech approach to pharmaceutical ordering

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Abstract

OBJECTIVE: To determine if a clinically structured, paperbased prescription form can modify pharmaceutical prescribing behavior without restricting physician freedom to select the most appropriate medication for an individual patient.

DESIGN: Uncontrolled, nonrandomized, time series design.

SETTING: The urgent care clinic of a university-affiliated, county-supported hospital that provides care for underserved, vulnerable populations.

PATIENTS: Patients (N=2,189) who had a prescription written at the intervention site during the study.

INTERVENTION: Four-phase interventions lasting 2 weeks each, with a washout period between each phase, consisting of: (1) collection of baseline data utilizing the traditional prescription blank, (2) introduction of the pre-formatted prescription form, (3) use of the pre-formatted prescription form with medication cost added, and (4) pre-formatted prescription form with target drug (ranitidine) removed.

MEASUREMENTS AND MAIN RESULTS: Physicians were less likely to prescribe ranitidine compared to cimetidine after the introduction of the cost information (P<.01) and again after the removal of ranitidine from the pre-formatted prescription form (P<.001).

CONCLUSIONS: A structured, paper-based prescription order form can shift prescribing practices without inhibiting physicians’ ordering freedom.

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Authors and Affiliations

  1. Received from the Department of Medicine, University of California-Los Angeles, Los Angeles, Calif

    Jeffrey J. Guterman MD, MS, Bruce A. Chernof MD & Pramod G. Gan MD

  2. the Department of Emergency Medicine, University of California-Los Angeles, Los Angeles, Calif

    Jeffrey J. Guterman MD, MS

  3. the Department of Ambulatory and Community Medicine, Olive View-UCLA Medical Center, Sylmar, Calif

    Jeffrey J. Guterman MD, MS, Bruce A. Chernof MD & Pramod G. Gan MD

  4. Foundation Health Plan, Woodland Hills, Calif

    Bruce A. Chernof MD

  5. University of California-Los Angeles School of Medicine, Los Angeles, Calif

    Beatriz Mares BS

  6. Los Angeles County Department of Health Services, Los Angeles, Calif

    Jeffrey J. Guterman MD, MS, Sandra G. Gross-Schulman MD, MPH, RN, Pramod G. Gan MD & Donald Thomas III MD

Authors
  1. Jeffrey J. Guterman MD, MS
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  2. Bruce A. Chernof MD
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  3. Beatriz Mares BS
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  4. Sandra G. Gross-Schulman MD, MPH, RN
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  5. Pramod G. Gan MD
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  6. Donald Thomas III MD
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Corresponding author

Correspondence to Jeffrey J. Guterman MD, MS.

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Guterman, J.J., Chernof, B.A., Mares, B. et al. Modifying provider behavior. J GEN INTERN MED 17, 792–796 (2002). https://doi.org/10.1046/j.1525-1497.2002.20144.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2002.20144.x

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