Methods for Development

Two key objectives of the Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) are to identify and evaluate the clinical and economic evidence supporting the use of a drug or treatment to make optimal drug therapy recommendations, and then to promote the adoption and use of the optimal drug therapy recommendations by health care professionals and consumers. To meet these objectives, COMPUS is building on existing evidence using information from systematic reviews and guidelines. The Rx for Change database contains summaries of highly relevant (or key) findings of systematic reviews of interventions to promote evidence-based prescribing and drug use. There are two areas of focus: interventions directed to Professionals and interventions directed to Consumers.

• Professionals Section
• Consumers Section
  

Timelines

• 2007 (March): Creation of the Rx for Change database. Reviews to March 2006, inclusive.
• 2009 (April): Database updated for the period of April 2006 to May 2008.
• 2009 (October): Database updated for the period of June 2008 to March 2009 (Professionals Section) and to September 2008 (Consumers Section)

Next Updates:

• 2010 (April): To include reviews for the period of April to September 2009 (Professionals Section) and to January 2009 (Consumers Section).

Organization of the Database

The reviews of interventions directed to Professionals are organized according to the intervention classification scheme of the Cochrane Effective Practice and Organisation of Care (EPOC) Group, with accompanying definitions from that classification scheme. Interventions are grouped into broad categories: professional, organizational, financial, regulatory, and structural. A comparable classification scheme available for interventions directed to Consumers. During the project, a classification system, plus definitions involving eight intervention categories, was developed. The Browse page allows you to access reviews using these classification schemes. The categories of intervention are listed from top to bottom, based on the amount of information provided.

Searching for Reviews

Potentially relevant systematic reviews were identified by detailed electronic searches and hand searches. Key systematic reviews were identified, based on methodological quality and on  being up to date.

Detailed information on the methodology used in searching for and identifying reviews can be viewed in the Professionals and Consumers sections.

Data Collection

A standardized data extraction form was developed and refined through consultation and piloting. The form summarized the evidence, methodological quality, and key characteristics for each review.

Reviews of Interventions Directed to Professionals or Organizations of Care

The data collection was performed by two reviewers and adjudication of discrepancies was handled by one of two senior reviewers, who also compiled the final dataset. Detailed information on the methodology used for data collection can be viewed in the Professionals section.

Reviews of Interventions Directed to Consumers

The data collection was performed by one reviewer a second reviewer verified this data abstraction; and differences were resolved by discussion. Detailed information on the methodology used for data collection can be viewed in the Consumers Section.

Quality Assessment of Systematic Reviews

The quality of the systematic reviews was assessed using AMSTAR (A MeaSurement Tool to Assess Reviews). This tool provides an overall quality rating on a scale of 0 to 11, where 11 represents a review of the highest quality. Categories of quality were determined, as follows: low (score 0 to 3), medium (score 4 to 7), and high (score 8 to 11).

Reviews of Interventions Directed to Professionals or Organizations of Care

The quality assessment was performed by two reviewers and adjudication of discrepancies was handled by one of two senior reviewers. Detailed information on the methodology used for quality assessment can be viewed in the Professionals section.

Reviews of Interventions Directed to Consumers

The quality assessment was performed in all cases by one reviewer and a second reviewer verified this assessment. Differences were resolved by discussion.

Synthesis, Presentation, and Rating of the Evidence

Individual Review Summaries

Results of the included reviews were analyzed, summarized, and reported quantitatively and descriptively. Data were organized into categories of overall results, and results related to prescribing. Broadly, results were reported as:

• vote counting plus reporting of absolute effect measures (with or without a measure of variability)
• vote counting plus reporting of relative effect measures (with or without a measure of variability)
• vote counting alone, by direction or statistical significance, depending on available information.

To standardize the reporting of the prescribing-related outcomes, the following categorizations were developed and employed: concordance, appropriate use, appropriate use - dosage, appropriate use - choice, appropriate use - route of administration, cost containment, and other.

Detailed information on the use of this categorization scheme can be viewed for the Professionals or Consumers sections.

Standardized statements and decision rules were used for reporting the evidence for the Results, Conclusions, and Effectiveness sections of each review summary. Detailed information on these statements and rules can be viewed in the Professionals and Consumers sections. 

Summaries of Intervention Classification Categories

To improve the usefulness of this database, overall summaries representing the evidence reported among reviews for a common intervention are provided. Standardized statements and decision rules were used for producing these summaries. Detailed information on these statements and rules can be viewed in the Professionals and Consumers sections. 

Structure of the Database

Intervention summaries and summaries of individual reviews were produced based on a template. Decisions about the amount and type of information presented were made jointly by the COMPUS and EPOC teams. More details about the fields within each summary type are available in the Professionals section.

A list of the individual studies included in each review is provided as a link from the individual review summary page. This list may not be comprehensive for each review. Detailed information on the methodology and reasons for missing references can be viewed in the Professionals and Consumers sections.

Study Team

• Dr. Jeremy Grimshaw, Principal Investigator
• Dr. Sophie Hill, Senior Advisor (Consumers)
• Dianne Lowe
• Caroline Kaufman
• Alain Mayhew
• Dr. Rebecca Ryan
• Nancy Santesso
• Adrienne Stevens
• Michelle Weir
• Julia Worswick