Research Paper On Provider Profiling AND/Or Changing Provider Behavior

Introduction The article upon which this article review is based is authored by Michael Cabana and Janet Coffman. The article features the findings of a review of clinical trials the examined the methods which are used in inducing and encouraging prescribing behavior change among providers and child health outcomes. The analysis of the clinical trials was aimed at reviewing the effectiveness of the various methods that are used in inducing and encouraging the change in the prescribing practices of physicians and the improvement of child health outcomes.Background This article is based on the consistently evolving best practices and the need for providers to stay updated. However, the pharmaceutical options that are available physician are changing as fast as new drugs are introduced in the market. Consequently, there is new information on the side effects, effectiveness, dosing options, indications and contraindications. This is the much information that the physicians have to consider when writing the prescriptions. The dynamism in the process of determining what prescription to give for a given disease condition contributes to the numerous gaps between everyday practice and evidence-based practice in prescribing medications. As a result, there is the risk of underutilization and overutilization of prescription medicine (Cabana & Coffnan, n.d). Additionally, there is the risk that physicians are prescribing drugs for the wrong conditions and situations. The background of the article is also influenced by other specific issues which are unique to diseases affecting children, hence making prescribing drugs to children challenging. For instance, the evidence base upon which pediatric prescribing is based is weaker compared to the evidence base upon which adult prescribing is based. This is because of the limited pharmacokinetic and pharmacodynamic data for the medication that is prescribed to children (Cabana & Coffnan, n.d). More often than not, pediatric doses for various medications prescribed for children are extrapolated from the clinical trials performed on medication that is manufactured for adults (Dunne, 2007). Despite the sufficiency of the short-term data that is extrapolated from clinical studies from medication manufactured for adults, the physical and cognitive development of pediatric patients has raised concerns over the long term effects of the medication on the development of the children (Hausner, 2008). These concerns may lead to resistance by providers to adopt new recommendations for treatment. It is on this premise that Michael Cabana and Janet Coffman review the effectiveness of different methods that are used in inducing and encouraging the change in the prescribing practices of physicians and the improvement of child health outcomes.Findings The review of different clinical studies highlighted different interventions that are used to induce and encourage the change in the prescribing practices of physicians and the improvement of child health outcomes. The prevalent components in these interventions include the use of educational materials, seminars or lectures, conferences, educational outreach visits, audit and feedback, patient-mediated interventions, reminders, policy changes, influence of opinion leaders and the use of clinical pathways. All the interventions in the clinical trials reviewed were aimed at improving the prescribing behavior of the providers. The main areas of disease focus in these interventions were asthma, diarrhea, use of antibiotics and malaria (Cabana & Coffnan, n.d). With regards to childhood asthma, the article found that interventions which were aimed at changing the systems of care or the practice organization found more success compared to those interventions which were aimed at changing the prescribing behavior of an individual. This finding was also consistent when the use of antibiotics in children was considered. For the many interventions under this area of focus, the review of the clinical studies found that providers overprescribed antibiotics of the broad spectrum of coverage (Finkelstein, 2008). The narrow spectrum antibiotics were commonly prescribed when neonatal sepsis was suspected (deMan et al., 2000). There were not many studies looking into malaria as a disease condition. However, one hour training sessions were deemed effective in improving the knowledge of the provided on the various prescription drugs for malaria (Nsimba, 2007). With regards to diarrhea, the clinical trials that were reviewed highlighted the effectiveness of different forms of provider education (Pagiya & Garner, 2005). Educational outreach visits, and a three-day training cause increase the use of oral rehydration solution in the treatment of diarrhea.Evaluation I agree with many of the emergent themes from this review of clinical trials. For instance, the interventions that were aimed towards structural changes in the current design of the practice achieved more success when compared to those interventions that were concerned with the change of individual provider. Additionally, the review found that multifaceted interventions (Grimshaw et al., 2001) stood a better chance of success when compared to single interventions which are focused on changing the behavior of an individual provider. I agree with these findings because providers need to overcome all the barriers in order to ensure that the manner in which he prescribes medication is in keeping with evidence-based practice. These barriers include unfamiliarity with the best practices in prescribing medication, the attitudes of the physician regarding whether or not he conquers with the established recommendations (Cabana & Coffnan, n.d).
The barriers do not just occur in one level and are not precipitated by a singular factor. For instance, these barriers occur both at the inter-personal and organizational, community and policy levels. The use of multifaceted approaches helps address the multiple barriers that could potentially hinder the change of behavior in a provider. I contend that the use of multiple interventions such as skills training with the aim of improving the self-efficacy of the physicians and their communication will among other things enhance adherence to recommendations and well as improve the patient outcomes. In addition, physicians receive different training and at different levels. They also have different skills and experiences. As such, they may be affected by different barriers through the various steps of change in the prescribing behavior. In this respect, multifaceted interventions stand a better change of overcoming the myriad of barriers (Cabana & Coffnan, n.d).Reflection The findings of the authors are not just significant to the pediatric physician. Even in the emergency medical services, there is new evidence on how to best improve the patient outcomes before they are delivered to the hospitals. The willingness of emergency medical personnel to adopt the new evidence-based practices is also influenced by several barriers. The findings of this article are crucial because they highlight how effectively different interventions would fair in inducing and encouraging behavior change among these personnel. For instance, I am very aware that any interventions that are aimed at achieving individual behavior change may not be very successful. I am also informed that the use of multifaceted interventions would be more effective in inducing and encouraging behavior change among the emergency medical services personnel because these multifaceted interventions address multiple barriers.

References

Cabana, D. and Coffnan, J. (n.d). Analysis of Published Trials Examining Methods to Change Provider Prescribing Behavior and Child Health Outcomes. Retrieved from http://www.who.int/childmedicines/progress/Published_trials.pdf
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