New evidence on stemming low-value prescribing

Posted on:
Michael L. Barnett
Shantanu Agrawal

This article was originally published by NEJM Catalyst on April 10, 2019. Interested in staying up to date with J-PAL North America and the Health Care Delivery Initiative? Sign up for our monthly newsletters here.

Health care policymakers and practitioners are increasingly pointing to overprescribing as a critical issue in the U.S. health care delivery system. Much of the attention has centered on opioids, as years of high prescribing along with other factors have culminated in a crisis. But the picture is equally concerning for other drug classes. For example, benzodiazepines drive a significant fraction of overdose hospitalizations, and overprescribing of antibiotics is raising the threat of bacterial resistance.

The scale of the problem requires effective, evidence-based solutions to reduce overprescribing. Historically, the standard approach has been to facilitate intensive education, training, and a review of physicians’ prescribing practices. While these methods can move the needle, they are often expensive and hard to scale up. Other classic approaches include the use of audit and feedback techniques and computer-generated alerts to provide information to practitioners about their recent performance. Unfortunately, although systematic reviews have shown that these methods can have positive effects, the impacts tend to be small in magnitude.

This body of evidence has left a gap between the need to stem overprescribing quickly and cheaply and the evidence-based tools available to accomplish this goal. Fortunately, evidence from new research suggests that simple interventions can be scalable, low cost, and effective for reducing overprescribing. In the present article, we first review recent light-touch “nudge” interventions on prescribing. We then discuss two recent studies, one of which we conducted, that deployed strong and surprising messages through letters to improve prescribing quality.

[To continue reading this post, please go to the article originally published by NEJM Catalyst.]

This is the third post in a five-part blog series on the J-PAL North America Health Care Delivery Initiative (HCDI). The first post shares reflections from Amy Finkelstein, J-PAL North America Co-Scientific Director and HCDI Chair, on the role of RCTs in US health care delivery. The second post highlights research results from workplace wellness programs and discusses why we should be skeptical of their impact. Stay tuned for more posts this week for other examples of how new rigorous evidence is informing health care policy in the US today.  

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