Reducing the prescribing of heavily marketed medications: a randomized controlled trial

J Gen Intern Med. 2009 Aug;24(8):897-903. doi: 10.1007/s11606-009-1013-x. Epub 2009 May 28.


Context: Prescription drug costs are a major component of health care expenditures, yet resources to support evidence-based prescribing are not widely available.

Objective: To evaluate the effectiveness of computerized prescribing alerts, with or without physician-led group educational sessions, to reduce the prescribing of heavily marketed hypnotic medications.

Design: Cluster-randomized controlled trial.

Setting: We randomly allocated 14 internal medicine practice sites to receive usual care, computerized prescribing alerts alone, or alerts plus group educational sessions.

Measurements: Proportion of heavily marketed hypnotics prescribed before and after the implementation of computerized alerts and educational sessions.

Main results: The 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%).

Conclusions: Computerized decision support is an effective tool to reduce the prescribing of heavily marketed hypnotic medications in ambulatory care settings.

Trial registration: Identifier: NCT00788346.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Decision Support Systems, Clinical / standards
  • Drug Industry / methods
  • Drug Industry / standards
  • Drug Prescriptions / standards*
  • Electronic Prescribing / standards*
  • Female
  • Humans
  • Hypnotics and Sedatives / therapeutic use
  • Internal Medicine / methods
  • Internal Medicine / standards
  • Male
  • Marketing / methods
  • Marketing / standards*
  • Medical Records Systems, Computerized / standards*
  • Middle Aged
  • Physicians / standards
  • Prescription Drugs / therapeutic use*
  • Professional Practice / standards


  • Hypnotics and Sedatives
  • Prescription Drugs

Associated data