BJORNSON, DARREL CURTIS; PHD
UNIVERSITY OF MINNESOTA, 1987
HEALTH SCIENCES, PHARMACY (0572)
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.
Social
Systems Simulation Group
P.O. Box 6904 San Diego, CA 92166-0904 Roland Werner, Principal Phone/FAX (619) 660-1603 |