Doctoral dissertation: Information sent to physicians may reduce potentially harmful prescribing of medicines
The excessive prescribing of certain medicines has been identified as one of the challenges in healthcare, causing adverse health effects and leading to additional costs. The increased availability of prescription opioids, for example, has been one of the factors contributing to the opioid crisis in the United States.
Since 2017, Kela has been sending physicians targeted feedback on the annually changing topic related to prescribing medicines. Recipients of the targeted prescription feedback are selected based on registry data from the previous year. The articles included in the doctoral dissertation examined the effects of prescription feedback from the years 2017, 2018, and 2019.
Prescription feedback reduced the prescribing of paracetamol-codeine combination products
The purpose of the feedback in 2017 was to raise physicians’ awareness of the prescribing practices of paracetamol-codeine combination products and to reduce the quantity of medicines prescribed to new patients in their first prescription.
According to the findings of the first article in the dissertation, prescription feedback reduced the prescribing of paracetamol–codeine combination products to new patients.
“The average package size decreased, and the prescribing of large packages containing more than 100 tablets also declined,” says Ahomäki. “The study also found that the effects were greater among physicians who frequently prescribed large volumes of these medicines. It has been observed that the quantity of opioids prescribed in the first prescription is linked to continued opioid use. Therefore, limiting the quantity of opioids prescribed to new patients may help reduce opioid-related health harms and the resulting costs.”
Feedback letter reduced the probability of prescribing tricyclic antidepressants
The second article examined the effects of the 2018 prescription feedback on the prescribing of tricyclic antidepressants and pregabalin, as well as on patients’ use of healthcare resources. The national treatment guidelines recommend avoiding the use of these medicines in the treatment of older patients.
“Our study found that the letter reduced the probability of prescribing tricyclic antidepressants and pregabalin to patients aged 75 and older,” explains Ahomäki. “The number of medications purchased by patients also decreased. No impact was observed on the use of healthcare services by patients.”
Prescription feedback had no observable effect on the prescribing of strong opioids
In the third article, Ahomäki investigated the effect of the 2019 prescription feedback on the prescribing of strong opioids. The feedback had no noticeable effect when considering all recipients, but it was observed that physicians who had not received previous information letters reduced their prescribing of fentanyl and oxycodone to new patients.
“This observation suggests that the effect of prescription feedback diminishes when it is used repeatedly,” says Ahomäki.
Ahomäki’s doctoral dissertation is based on comprehensive register data from Kela and the Finnish Institute for Health and Welfare, including information on prescription medication purchases, prescriptions, and healthcare visits. The study used econometric methods to assess the causal effects of prescription feedbacks.
M.Sc. (Econ.) Iiro Ahomäki will defend his doctoral dissertation ”Information Interventions and Physician Prescribing Behavior” on Friday 16 May 2025 at 12 noon in the Seminarium assembly hall (S212) at the Ģֱ. His opponent is Docent, Research Director Lauri Sääksvuori (University of Turku and Finnish Institute for Health and Welfare), and the custos is Professor Jaakko Pehkonen (Ģֱ). The event will be held in Finnish.
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More information:
Iiro Ahomäki
iiro.l.j.ahomaki@jyu.fi
