Abstract
The economic impact of continuous professional development (CPD) education is incompletely understood. To systematically identify and synthesize published research examining the costs associated with physician CPD for drug prescribing. MEDLINE, Embase, PsycInfo, and the Cochrane Database were searched from inception to April 23, 2020, for comparative studies that evaluated the cost of CPD focused on drug prescribing. Two reviewers independently screened all articles for inclusion and reviewed all included articles to extract data on participants, educational interventions, study designs, and outcomes (costs and effectiveness). Results were synthesized for educational costs, health care costs, and cost-effectiveness. Of 3338 articles screened, 38 were included in this analysis. These studies included at least 15 659 health care professionals and 1 963 197 patients. Twelve studies reported on educational costs, ranging from $281 to $183 554 (median, $15 664). When economic outcomes were evaluated, 31 of 33 studies (94%) comparing CPD with no intervention found that CPD was associated with reduced health care costs (drug costs), ranging from $4731 to $6 912 000 (median, $79 373). Four studies found reduced drug costs for 1-on-1 outreach compared with other CPD approaches. Regarding cost-effectiveness, among 5 studies that compared CPD with no intervention, the incremental cost-effectiveness ratio for a 10% improvement in prescribing ranged from $15 390 to $437 027 to train all program participants. Four comparisons of alternative CPD approaches found that 1-on-1 educational outreach was more effective but more expensive than group education or mailed materials (incremental cost-effectiveness ratio, $18-$4105 per physician trained). In this systematic review, CPD for drug prescribing was associated with reduced health care (drug) costs. The educational costs and cost-effectiveness of CPD varied widely. Several CPD instructional approaches (including educational outreach) were more effective but more costly than comparators.
Highlights
Inappropriate prescribing harms patients and wastes resources.[1]
In this systematic review, continuous professional development (CPD) for drug prescribing was associated with reduced health care costs
We defined CPD as “activities intended to promote or measure the clinical knowledge/skills of physicians in independent medical practice through courses or assessments delivered in any modality or venue, whether or not continuing medical education (CME) credit is awarded; or self-directed learning or self-assessment activities for which CME credit is awarded.”[16] (See the eBox in the Supplement for additional operational definitions.) From these studies we identified all CPD activities that addressed the clinical topic of drug prescribing
Summary
Inappropriate prescribing (including prescription errors, overuse and underuse of medications, and unnecessarily expensive medications) harms patients and wastes resources.[1] Up to one-third of prescriptions are inappropriate,[2] and these inappropriate prescriptions are associated with suboptimal clinical outcomes[3] and large financial burden.[4,5] With expanding drug formularies, increasing patient comorbidities, and progressively individualized treatment recommendations, Open Access. Educational interventions (eg, audit and feedback as well as educational outreach) have overall favorable effects on practitioner performance and patient outcomes.[6,9,10,11,12,13,14]
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