The Rx for Change database summarizes current research evidence about the effects of strategies to improve drug prescribing practice and drug use. This database houses summaries of key findings from systematic reviews that evaluate the effects of strategies targeting professionals, the organization of health care, and consumers.
The database was initially published on-line in April 2007. An update of the database was published October 2009.
For example, a hospital changing from a university academic centre to a public institution.
No reviews were located that assessed this intervention for evidence based prescribing and drug use.
Distribution of published or printed recommendations for clinical care, including clinical practice guidelines, audio-visual materials and electronic publications. The materials may have been delivered personally or through mass mailings.
Health care providers who have participated in conferences, lectures, workshops or traineeships.
Inclusion of participating providers in discussion to ensure that they agreed that the chosen clinical problem was important and the approach to managing the problem was appropriate.
Use of a trained person who met with providers in their practice settings to give information with the intent of changing the provider's practice. The information given may have included feedback on the performance of the provider(s). Can also be referred to as "academic detailing".
Use of providers nominated by their colleagues as 'educationally influential'. The investigators must have explicitly stated that their colleagues identified the opinion leaders.)
New clinical information (not previously available) collected directly from patients and given to the provider e.g. depression scores from an instrument.
Any summary of clinical performance of health care over a specified period of time. The summary may also have included recommendations for clinical action. The information may have been obtained from medical records, computerized databases, or observations from patients.
Patient or encounter specific information, provided verbally, on paper or on a computer screen, which is designed or intended to prompt a health professional to recall information. This would usually be encountered through their general education; in the medical records or through interactions with peers, and so remind them to perform or avoid some action to aid individual patient care. Computer aided decision support is included.
Patient or encounter specific information, provided on a computer screen targeting the dosage of the medication.
Patient or encounter specific information, provided on a computer screen aimed at automating the ordering of medication.
Use of personal interviewing, group discussion ('focus groups'), or a survey of targeted providers to identify barriers to change and subsequent design of an intervention that addresses identified barriers.
Varied use of communication that reached great numbers of people including television, radio, newspapers, posters, leaflets, and booklets, alone or in conjunction with other interventions; (ii) targeted at the population level.
Other professional interventions not addressed above.
Any combination of two or more professional, organisational, financial, structural or regulatory interventions designed to improve prescribing practices or other health provider behaviour.
Strategies enabling consumers to know about their treatment and their health. Interventions include those to educate, provide information or to promote health or treatment. Interventions may be simple or multifaceted, and include those seeking solely to educate or inform consumers about treatment or health. They also include those seeking to educate, inform or promote health as part of a multifaceted intervention for managing health or treatment.
Interventions which focus on the adoption or promotion of health behaviours and treatment behaviours, such as adherence to medicines. Included are interventions at an individual level that address behaviour change for both the under-use and overuse of medicines. Strategies may include a practical application or component to assist consumers in taking their medicines correctly - such as those involving reminder devices, pre-packaging of multiple medicines, or different or simplified drug formulations.
Strategies that focus on the acquisition of skills relevant to drug use. These interventions are aimed at consumers to help them develop a broad set of competencies around medicines use, such as self-care or self-management; self-monitoring and self-testing for the purposes of treatment; and training in the correct use of devices to deliver treatment, or the correct use of the treatment itself. Interventions are also aimed at the promotion of health.
Interventions which provide assistance and encouragement to help consumers to cope with and manage their health and ongoing medication use, such as counseling and follow-up in relation to medicines use. Interventions included here can be targeted at patients or at carers.
Strategies to involve consumers in decision-making about medicines. Interventions include those which aim to help consumers make decisions about medicine use; to encourage consumers to express their beliefs, values and preferences about treatments and care; to optimise communication with consumers about drug use and related issues.
Strategies to prevent or manage adverse events of treatment and complications of disease. Included are interventions for self-testing and self-monitoring in relation to treatment; and interventions to promote knowledge, prevention or action in an emergency or crisis related to a disease, such as action plans and management when exacerbations of a disease occur. Strategies can be directed to individuals to minimise their individual risks or harms associated with treatment; or they may represent interventions with public health or community-level implications (e.g. reduction of medicines use, such as use of antibiotics; or augmentation of medicines use, such as immunisation uptake).
Interventions to improve the total package of care, the coordination of care, or the integration of care delivered. Interventions include those which involve the substitution or expansion of one type of care or means of delivering care in relation to drug use and/or prescribing. It also includes interventions that aim to overcome system barriers to treatment with medicines, including financial barriers.
Interventions to involve consumers and/or carers in decision-making processes on prescribing and drug use at a system level.
The expansion of pharmacist roles to include new tasks
The expansion of nursing roles to include new tasks
Also known as 'professional substitution', specialist role' or 'boundary encroachment', this includes the shifting of roles among health professionals and expansion of role to include new tasks. See also revision of professional roles - nursing and revision of professional roles - pharmacy intervention categories for specified nursing or pharmacy led care.
Presence and organisation of quality monitoring mechanisms
Change in format or structure of medical record, such as switching to computerized records.
For example, a change of location of nursing stations, inclusion of equipment where technology in question is used in a wide range of problems and is not disease specific.
No reviews were located that assessed this intervention for evidence based prescribing and drug use.
For example, additional treatments being made available to the patient.
No reviews were located that assessed this intervention for evidence based prescribing and drug use.
For example, moving a family planning service from a hospital to a school.
Creation of a new team of health professionals of different disciplines or additions of new members to the team who work together to care for patients.
An intervention which includes one or many episodes of care for inpatients or outpatients. Continuity of care also includes arrangements for follow-up and case management, including co-ordination of assessment, treatment and arrangement for referrals.
Changes in numbers, types or qualifications of staff.
No reviews were located that assessed this intervention for evidence based prescribing and drug use.
For example, telephone or video links between specialists and general practitioners.
Changes in structure or delivery which target patients
No reviews were located that assessed this intervention for evidence based prescribing and drug use.
Bringing together of services across sectors or teams or the organisation of services to bring all services together at one time
For example, interventions to improve morale of staff.
No reviews were located that assessed this intervention for evidence based prescribing and drug use.
For example, a hospital changing from a university academic centre to a public institution.
No reviews were located that assessed this intervention for evidence based prescribing and drug use.
Other organisational (provider) interventions not addressed above.
Other structural interventions not addressed above.
Any intervention that aims to change health services delivery by regulation or law.