Evidence for Interventions Directed to Consumers in the <em>Rx for Change</em> Database: Update and Expansion - Do New Reviews Broaden the Scope of the Field and Expand the Definition of Evidence-Based Prescribing for and Drug Use by Consumers?

Abstract

Background: Much research has focused on the prescribing habits of physicians. The Canadian Agency for Drugs and Technologies in Health (CADTH) created a database of research on drug prescribing called Rx for Change. This database focuses both on interventions directed to professionals as well as interventions directed to consumers in relation to evidence-based prescribing/ drug use. The consumer arm of the Rx for Change database has been created and maintained by the Cochrane Consumers and Communication Review Group (CC&CRG, Australia). The database was first populated in 2006 with Cochrane and DARE (Database of Abstracts and Reviews of Effects) systematic review articles collected after standard literature searches as well as extensive hand-searching of both databases. This database was scheduled for an update in 2008. An important question that arises is whether the new reviews screened and identified broaden the scope of the field and expand the definition of evidence-based prescribing for and drug use by consumers. Objectives: This study sought to identify new reviews appropriate for addition to the CADTH Rx for Change database. Following this, the body of new literature was assessed for scope and contribution to the field. Methods: A search was performed by hand of the Cochrane Library from Issue 3, 2006 until the present—Issue 1, 2008. Criteria developed by the CC&CRG during the initial population of the database were used to identify and to sort reviews relevant to prescribing and drug use, a task performed independently by two researchers, with any discrepancies in selection discussed. A third researcher was available to resolve disputes where these arose. Detailed data was extracted from each high and moderate relevance review identified, and the data was summarized in a format acceptable for input into the Rx for Change database. Data extracted included detailed descriptions of the interventions evaluated by each review. The quality of each review was assessed using the AMSTAR tool. Statistical and methodological data were re-expressed as absolute risk differences or in standard narrative formats where suitable numerical data was not available. The themes of the relevant reviews were mapped to a consumer intervention taxonomy developed by the CC&CRG, in order to begin to organize the evidence relating to consumer prescribing/ drug use. A consumer outcome taxonomy for prescribing and drug use was also adapted from the outcome taxonomy developed by the CC&CRG and utilized in data extraction in order to standardize the language used in this field. Finally, the effectiveness of the intervention under study was mapped to standardized effectiveness statements also developed by the CC&CRG. The number of new reviews was quantified and the scope of the new data now included in the database was evaluated and compared to the pool of data originally included in the database in 2006. Results: After screening several hundred reviews, five new Cochrane reviews published in the period between Cochrane Library Issue 3, 2006 and Issue 1, 2008 inclusive were deemed to be high relevance for the Rx for Change database. However, two of these had significant errors requiring clarification by the authors and are therefore excluded from this analysis. A further five reviews were graded as moderate relevance and eleven were low or very low relevance. This is a total of 21 new Cochrane reviews for inclusion in the consumer category of the Rx for Change database. Conclusions: The field of evidence-based prescribing for and drug use by consumers has continued to be an area of growth in new research. Several new highly relevant Cochrane systematic reviews have been published between 2006 and 2008 that expand the populations and diagnoses specifically covered in the Rx for Change database. In addition, they add to and expand the literature that looks at consumers as decision-makers rather than merely recipients of medical interventions. The consumer intervention taxonomy developed by the Cochrane Consumers and Communication Review Group has been used to help establish a framework for the field and allows accurate assessment of the gaps and advances in the literature. This is an exciting and highly relevant field in the climate of patient autonomy and evidence-based medicine, and both the literature and the Rx for Change database will continue to grow.