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Assessing the effectiveness and cost-effectiveness of audit and feedback on physician’s prescribing indicators: study protocol of a randomized controlled trial with economic evaluation

Fatemeh Soleymani12, Arash Rashidian1348*, Rassoul Dinarvand15, Abbas Kebriaeezade16, Mostafa Hosseini7 and Mohammad Abdollahi16

Author Affiliations

1 Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran

2 National Committee on Rational Drug Use, Food and Drug Organization, Ministry of Health and Medical Education, Tehran, Iran

3 Department of Health Management and Economic, School of Public Health, TUMS, Tehran, Iran

4 Knowledge Utilization Research Center, TUMS, Tehran, Iran

5 Department of Pharmaceutics, Faculty of Pharmacy and Nanotechnology Research Center, TUMS, Tehran, Iran

6 Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, TUMS, Tehran, Iran

7 Department of Epidemiology and Biostatistics, School of Public Health, TUMS, Tehran, Iran

8 National Institute of Health Research, Tehran University of Medical Sciences, No 78, Italia Ave, Tehran, Iran

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DARU Journal of Pharmaceutical Sciences 2012, 20:88  doi:10.1186/2008-2231-20-88

Published: 6 December 2012



Physician prescribing is the most frequent medical intervention with a highest impact on healthcare costs and outcomes. Therefore improving and promoting rational drug use is a great interest. We aimed to assess the effectiveness and cost-effectiveness of two forms of conducting prescribing audit and feedback interventions and a printed educational material intervention in improving physician prescribing.


A four-arm randomized trial with economic evaluation will be conducted in Tehran. Three interventions (routine feedback, revised feedback, and printed educational material) and a no intervention control arm will be compared. Physicians working in outpatient practices are randomly allocated to one of the four arms using stratified randomized sampling. The interventions are developed based on a review of literature, physician interviews, current experiences in Iran and with theoretical insights from the Theory of Planned Behavior. Effects of the interventions on improving antibiotics and corticosteroids prescribing will be assessed in regression analyses. Cost data will be assessed from a health care provider’s perspective and incremental cost-effectiveness ratios will be calculated.


This study will determine the effectiveness and cost-effectiveness of three interventions and allow us to determine the most effective interventions in improving prescribing pattern. If the interventions are cost-effective, they will likely be applied nationwide.

Trial registration

Iranian Registry of Clinical Trials Registration Number: IRCT201106086740N1Pharmaceutical Sciences Research Center of TUMS Ethics Committee Registration Number: 90-02-27-07

Intervention study; Rational drug use; Audit and feedback; Printed educational material; Iran