Differential prescribing of inhaled corticosteroids in New Zealand general practice.

AIM: To determine how inhaled budesonide, beclomethasone and fluticasone are prescribed by general practitioners in New Zealand. METHODS: Retrospective study of computerised clinical records from 42 general practices in New Zealand for the period 1 July 1997 to 30 June 1998. The study population comprised 174 929 consulting patients, of whom 9878 patients were prescribed budesonide, fluticasone, or beclomethasone with full dosing instructions. RESULTS: The mean daily prescribed dose was higher for patients receiving inhaled budesonide (886 microg) than beclomethasone (547 microg), a difference of 339 microg (95% CI 311 microg to 367 microg), and fluticasone (508 microg), a difference of 378 microg (95% CI 344-412). The difference between mean daily prescribed doses of beclomethasone and fluticasone was 39 microg (95% CI 15-63). The overall difference was consistent across age groups and with different types of inhalation device. Evidence of systematic prescribing of higher doses of budesonide to patients with more severe asthma was not found. Patients prescribed fluticasone were more likely to have been prescribed oral steroids in the preceding year. CONCLUSIONS: Conclusions about the relative potencies of inhaled corticosteroids cannot be made with the data presented. However, data presented show that inhaled corticosteroids have not been prescribed in line with their reported relative potencies. This study provides benchmark data for the prescribing of inhaled steroids in New Zealand general practice.

Computer-generated patient education materials: do they affect professional practice? A systematic review.

A systematic search of seven electronic databases was done to identify randomized controlled trials that assessed the effect of computer-generated patient education material (PEM) on professional practice. Three studies met the authors' criteria. All three studies involved preventive care. All used a complex intervention of which computer-generated PEM was a major component. Improvements in practice were seen in all studies, although these gains were generally modest. One study showed improvement in patient outcomes. Mann-Whitney statistics calculated for the studies' outcome measures ranged from 0.48 to 0.66, equivalent to risk differences of -4 to 32 percent. Computer-generated PEM seems to have a small, positive effect on professional practice. The small number of included studies and the complex nature of the interventions makes it difficult to draw conclusions about the ability of computer-generated PEM to change professional practice. Future work should involve well-defined interventions that can be clearly evaluated in terms of effect and cost.