As many as one-third of prescriptions are inappropriate (ie, prescription errors, overuse and underuse of medications, or unnecessarily expensive medications), leading to suboptimal outcomes, a large financial burden, and wasted resources. Restrictive interventions to optimize prescribing, such as prioritized formularies, prior authorizations, and computerized decision support, have benefits, but may be associated with treatment delays and negative impacts on clinicians’ professional identity. By contrast, educational interventions have demonstrated overall favorable effects on clinician performance and patient outcomes.
Dr David Cook and colleagues conducted a systematic review of 38 studies to determine the comparative costs and benefits of physician continuous professional development (CPD) for drug prescribing and the CPD features that are associated with improved cost-benefit outcomes. CPD was defined 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.” Most of the studies involved physicians in private or independent practice, and 79% involved patients in an ambulatory setting.
Across the studies, CPD was associated with reduced healthcare costs (median drug cost-savings of $79,373) compared with no training, while mean educational costs were $32,676. CPD approaches associated with greater reductions in drug costs included one-on-one outreach education, interactive seminars, and year-round activities, although these reductions must be weighed against higher costs to implement these approaches. More-intensive CPD—particularly one-on-one outreach education—was associated with improved prescribing outcomes but incurred higher education costs, ranging from $3 to $4,105 per physician per standardized effectiveness change.
High level
The results of this analysis suggest that physician CPD for drug prescribing can effectively reduce healthcare costs. The authors concluded that more and better educational cost evaluations are needed to measure the economic impact of CPD approaches. Variance in results from the different studies in this analysis illustrates that focused, immediate outcomes (eg, fewer prescriptions, cheaper drug choices) may differ from broad, delayed economic measures, and should be explicitly stated in future economic analyses. Additionally, since time expenses (ie, opportunity cost of lost wages or productivity) represented 55% of educational costs, future economic studies of education should include measures of both quantity and price of time.
Ground level
When making education decisions, questions of effectiveness must be considered along with economic data to inform judgments of value. Educational costs and cost-effectiveness of CPD varied widely; there was a 50-fold difference in highest vs lowest mean cost per CPD in this review. Local factors, resources, priorities, and values should all be included in community decisions about CPD.
