• Robert J Fortuna, Fang Zhang, Dennis Ross-Degnan, Francis X Campion, Jonathan A Finkelstein, Jamie B Kotch, Adrianne C Feldstein, David H Smith, and Steven R Simon.
• Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA. rfortuna@post.harvard.edu
• J Gen Intern Med. 2009 Aug 1;24(8):897-903.

ContextPrescription drug costs are a major component of health care expenditures, yet resources to support evidence-based prescribing are not widely available.ObjectiveTo evaluate the effectiveness of computerized prescribing alerts, with or without physician-led group educational sessions, to reduce the prescribing of heavily marketed hypnotic medications.DesignCluster-randomized controlled trial.SettingWe randomly allocated 14 internal medicine practice sites to receive usual care, computerized prescribing alerts alone, or alerts plus group educational sessions.MeasurementsProportion of heavily marketed hypnotics prescribed before and after the implementation of computerized alerts and educational sessions.Main ResultsThe activation of computerized alerts held the prescribing of heavily marketed hypnotic medications at pre-intervention levels in both the alert-only group (adjusted risk ratio [RR] 0.97; 95% CI 0.82-1.14) and the alert-plus-education group (RR 0.98; 95% CI 0.83-1.17) while the usual-care group experienced an increase in prescribing (RR 1.31; 95% CI 1.08-1.60). Compared to the usual-care group, the relative risk of prescribing heavily marketed medications was less in both the alert-group (Ratio of risk ratios [RRR] 0.74; 95% CI 0.57-0.96) and the alert-plus-education group (RRR 0.74; 95% CI 0.58-0.97). The prescribing of heavily marketed medications was similar in the alert-group and alert-plus-education group (RRR 1.02; 95% CI 0.80-1.29). Most clinicians reported that the alerts provided useful prescribing information (88%) and did not interfere with daily workflow (70%).ConclusionsComputerized decision support is an effective tool to reduce the prescribing of heavily marketed hypnotic medications in ambulatory care settings.Trial Registrationclinicaltrials.gov Identifier: NCT00788346.

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