( iods. Provider ordering behavior was mo...)Is it Possible to Change Prescribing Habits?

iods. Provider ordering behavior was monitored, focusing on the number of medication orders not completed and the number of rule-associated laboratory test orders initiated after alert display. The investigators found that the rule processed 16,291 times during the study period on all possible medication orders: 7,017 during the pre-intervention period (prescribing doctors did not receive alerts) and 9,274 during the post-intervention period (prescribing doctors received alerts). During the post-intervention period, an alert was displayed for 11.8% (1,093 out of 9,274) of the times the rule processed, with 5.6% of alerts being for “missing laboratory values,?6.0% for “abnormal rule-associated laboratory?values, and 0.2% for both types of problems.

Providers did pay attention to the alerts; they increased ordering of the rule-associated laboratory test when an alert was displayed (39% at baseline versus 51% post-intervention, p < 0.001), thus showing that the rules had a significant ability to change the ordering behavior of the provider, said the authors. The strongest effect occurred when providers where alerted to “missing?laboratory results (42% increase), the investigators noted. There was less of an effect on ordering behavior when the alert informed the provider of the existence of an abnormal laboratory value (23% increase), which may imply that the cutoff values for the “abnormal?trigger were set too low, suggested the authors. However, there was only a modest effect on halting the ordering of medications, and this was limited to occasions in which the alert presented an abnormal laboratory value in which case there was almost a doubling in order cessation.

There are limitations to the study. For example, the intervention focused on a specific group of drug–laboratory interactions and thus the results may not be generalizable to other types of interventions. In addition, the setting was a single primary-care clinic outpatient setting within a
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Source:PLoS Medecine

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