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For sale: physicians' prescribing data.

New England Journal of Medicine (Impact Factor: 54.42). 07/2006; 354(26):2745-7. DOI: 10.1056/NEJMp068125
Source: PubMed
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    ABSTRACT: Background Evidence shows that clinical audit and feedback can significantly improve compliance with desired practice, but it is unclear when and how it is effective. Audit and feedback is likely to be more effective when feedback messages can influence barriers to behavior change, but barriers to change differ across individual health-care providers, stemming from differences in providers¿ individual characteristics.DiscussionThe purpose of this article is to invite debate and direct research attention towards a novel audit and feedback component that could enable interventions to adapt to barriers to behavior change for individual health-care providers: computer-supported tailoring of feedback messages. We argue that, by leveraging available clinical data, theory-informed knowledge about behavior change, and the knowledge of clinical supervisors or peers who deliver feedback messages, a software application that supports feedback message tailoring could improve feedback message relevance for barriers to behavior change, thereby increasing the effectiveness of audit and feedback interventions. We describe a prototype system that supports the provision of tailored feedback messages by generating a menu of graphical and textual messages with associated descriptions of targeted barriers to behavior change. Supervisors could use the menu to select messages based on their awareness of each feedback recipient¿s specific barriers to behavior change. We anticipate that such a system, if designed appropriately, could guide supervisors towards giving more effective feedback for health-care providers.SummaryA foundation of evidence and knowledge in related health research domains supports the development of feedback message tailoring systems for clinical audit and feedback. Creating and evaluating computer-supported feedback tailoring tools is a promising approach to improving the effectiveness of clinical audit and feedback.
    Implementation Science 01/2015; 10(1):12. DOI:10.1186/s13012-014-0203-z · 3.47 Impact Factor
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    ABSTRACT: INTRODUCTION: Since World War II, the pharmaceutical industry has consolidated itself as an important and lucrative economic activity. Considering that the prescribers are physicians, the industry draws on heavy advertising and perks and benefits, beginning early in medical school. OBJECTIVES: The objectives were to identify ethical perceptions among medical students in early medical school, besides comparing the various groups comprising the sample. Sample and methods: This was a cross-sectional, descriptive study based on the application and analysis of a questionnaire on the relationship between physicians and the pharmaceutical industry, answered by 94 second-year medical students. Statistical analysis used the Wilcoxon's and Fisher's exact tests. Statistical significance was set at p = 0.5. RESULTS: The answers were similar to the Code of Medical Ethics, last revised in 1988. In the comparison of the groups concerning the statement on the need for more time devoted to ethical issues, there was a difference between religious and non-religious students. DISCUSSION: Students were aware of the pharmaceutical industry's influence, although they were unaware of some of its marketing mechanisms and the fact that they were vulnerable to advertising within the medical school setting. CONCLUSION: The students' ethical perceptions were largely homogeneous and consistent with the Code of Medical Ethics. They acknowledged the need for an on-going discussion on the subject.
    Revista Brasileira de Educação Médica 12/2010; 34(4):515-524. DOI:10.1590/S0100-55022010000400006
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    ABSTRACT: The healthcare system creates a vast amount of data that are utilized by a wide variety of entities for a multitude of purposes. Physicians have traditionally been unable to control who has access to their data or how their data are used. The widespread adoption of the Electronic Health Record (EHR) by physicians will create a larger and more valuable healthcare data market with broad implications for the healthcare system. It is, therefore, important for physicians to understand the evolving healthcare data market and the importance of maintaining ownership of and control over their electronic health data. Several entities, including private health insurance companies, federal payers, medical societies, and pharmaceutical companies are increasingly utilizing healthcare data to drive reimbursement policies and commercial initiatives. Given the critical importance that EHR data will play in multiple aspects of the healthcare industry, it is in physicians' interest to maintain ownership and control of the healthcare data that they generate. It would be prudent for physicians to exercise caution before relinquishing data rights to entities that may sell the data to payers or other customers with whom physicians' interests may not be aligned.
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