Fewer bad prescriptions better for patients and healthcare system
Manitoba doctors are providing safer, more appropriate care to patients with mental-health conditions, thanks to an experimental program directed at physicians’ prescribing behaviours. Called IMPRXOVE for “Improving Medication Prescribing and Outcomes Via Medical Education,” the program provides educational feedback by mail to doctors when one of their prescriptions might be inappropriate. The program included over 1,100 family doctors, psychiatrists, and pediatricians over two years. It is the first of its kind in a public healthcare setting like Canada’s.
The Manitoba Centre for Health Policy, in the University of Manitoba’s College of Medicine, Faculty of Health Sciences, undertook a rigorous evaluation of IMPRXOVE to test whether doctors changed their prescriptions in response to the letters. Using comparison groups, MCHP found that doctors who received educational packages significantly reduced potentially inappropriate prescribing for sleeping pills and benzodiazepines, a type of sedative medication that includes Valium-like drugs. These are commonly prescribed for many conditions, so a reduction in their inappropriate use is good news for the health of Manitobans.
“While these medications are valuable and helpful when used judiciously,” says Murray Enns, Head of psychiatry (U of M) one of the study authors, “there can be significant hazards, particularly when patients receive multiple medications, high doses, or when advancing age increases the risks. These risks include accidents and confusion, especially among the elderly. Benzodiazepines are also potentially habit-forming, and a small group of patients may abuse them.”
Manitoba benefits from a centralized database that records prescription data from community pharmacies. When a potentially unsafe pattern is identified, a letter is sent to the doctor that summarizes current medical evidence related to the case. It is up to the doctor to decide whether his or her decision was appropriate given the circumstances, or, where the issue is not directly within the doctor’s control, to discuss it with the patient.
Fewer inappropriate prescribing patterns will result in fewer adverse events, and, in turn, reduce the burden on the healthcare system, including emergency rooms and the prescribing doctors themselves.
MCHP’s evaluation results will inform how IMPRXOVE continues to be administered, making it more effective by changing or adding medications or prescribing patterns included in the program. The success of this pilot program in Manitoba will help direct how other provinces look to improve the prescribing practices of their doctors.
The full report can be downloaded from the MCHP website.
MCHP is a research unit in the University of Manitoba’s College of Medicine, Faulty of Health Sciences. It’s also a research centre of excellence that conducts world class population-based research on health services, population and public health, and the social determinants of health. The work of MCHP supports the development of evidence-informed policy, programs and services that maintain and improve the health and well-being of Manitobans.