Promoting Optimal Antibiotic Therapy for Otitis Media Using Commercially Sponsored Evidence-Based Detailing: A Prospective Controlled Trial *

Abstract

INTRODUCTION: Academic detailing, typically conducted by impartial advisors, can optimize prescribing behavior. The objective of this prospective controlled trial was to determine if evidence-based detailing conducted by a pharmaceutical manufacturer can also improve physician prescribing habits.

MATERIALS AND METHODS: Physicians in eight Ontario regions were randomized to receive manufacturer detailing at least twice over six months using either an evidence-based educational pamphlet reviewing antibiotic therapy for acute otitis media or regular detailing. Relative percent changes of market share pre- and post-intervention were measured using a retail pharmacy administrative prescription database assembled by IMS Canada. Multivariable linear regression analysis was done using pre- and post-intervention market share differences for each product as the dependent variable and accounting for baseline market share, sex of prescribing physician, prescribing physician location, and years since graduation as covariates.

RESULTS: Change in market share for amoxicillin, pivampicillin, erthyromycin-sulfisoxazole, or any third-line agents (cefixime, amoxicillin clavulanate, or cefaclor) was not significantly different between intervention and control regions. Trimethoprim-sulfamethoxazole market share decreased significantly between intervention and control regions. Most variation in prescribing was accounted for by the differences in baseline antibiotic market shares, sex of the prescribing physician, and the years since physician graduation.

CONCLUSIONS: Most desired changes in prescribing did not occur. This was a small study with limited capacity to detect between-group differences, however, and so further studies are needed before the potential for harnessing the marketing resources of industry to conduct ‘academic detailing’ is ruled out.