Program challenges prescribing practices

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This article was published 02/02/2015 (3978 days ago), so information in it may no longer be current.

A PROVINCIAL program that flags potentially inappropriate physician prescribing practices has been found to be effective in reducing the questionable use of sleeping pills and certain anti-anxiety drugs.

The Manitoba Centre for Health Policy said in a recent report the government’s IMPROVE (Improving Medication Prescribing and Outcome Via Medical Education) program has led to safer and more effective care for patients with mental-health conditions.

It said when physicians were informed their prescribing practices to particular patients lay outside established guidelines, many responded positively.

Since 2011, Manitoba Health has begun to use a computer program to analyze certain prescription practices based on prescription information provided by pharmacists.

If the program flags potentially inappropriate prescribing, the department will fire off a letter and perhaps a package of information to the doctor. The centre for health policy was commissioned to study whether the letters had a positive effect on prescribing practices, and it appears they do.

The MCHP found doctors who received educational packages “significantly reduced potentially inappropriate prescribing for sleeping pills and benzodiazepines,” which are used to treat anxiety, insomnia and other conditions.

“While these medications are valuable and helpful when used judiciously,” said Dr. Murray Enns, 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.”

The province launched IMPROVE in 2011. The MCHP study measured results during the program’s first 18 months.

Patricia Caetano, executive director of provincial drug programs for Manitoba Health, said the program is unique in Canada in the breadth of drugs that can be monitored. In some jurisdictions, monitoring is limited to certain classes of drugs, such as opioids. That is being done in Manitoba, as well.

“In no way was the program set up to be punitive or disciplinary to physicians, but rather purely educational,” Caetano said. “It’s about increasing awareness and helping a physician to monitor that patient for optimal drug utilization.”

Caetano said the province is looking at ways to expand the program to tackle other issues, such as the treatment of diabetes. The program could be used to monitor whether diabetics were routinely obtaining insulin, for example. If there is an issue, the physician could be notified. Caetano said any new program applications would be discussed with physicians beforehand, and patient privacy issues would be taken into account.

Dr. Anna Ziomek, registrar with the Manitoba College of Physicians and Surgeons, said the report shows physicians will change their prescribing practices if they receive proper feedback.

“It was an excellent trial, because people were randomized so you had no idea who was getting the feedback letters and who wasn’t. The people who got the letters clearly made a change, and the only reason they would have made that change is because they received the letter,” she said.

larry.kusch@freepress.mb.ca