A substantial proportion of prescriptions written by physicians are not evidence based, which can result in drug abuse and misuse, increased morbidity and mortality, and rising health care costs. Although a variety of factors can influence physician prescribing, sponsored messaging by industry such as pharmaceutical companies has been shown to lead to non-evidence-based prescribing (non-EBP). As the healthcare industry has embraced health information technology (HIT) and physicians have increased their use of smartphones and tablets with point-of-care decision-making with their patients, sponsored messaging has begun to penetrate physicians' HIT environment. Because this form of targeted marketing by pharmaceutical companies is relatively new and not completely understood, we need to examine its relationships with the factors (system-level, physician-level and patient-level) that have been known to lead to non-EBP. Additionally, training programs are needed to reaffirm the basic principles of EBP in the presence of sponsored messaging in physicians' health IT environment. Thus, we have developed a Web-based HIT intervention, titled SMARxT, rooted in the tenets of media literacy and targeted at physicians-in-training (residents), in order to teach them how to effectively navigate their HIT environment and counteract sponsored messaging. In order to determine the preliminary efficacy, feasibility and acceptability of SMARxT for residency programs, this HIT intervention needs to be pilot tested and evaluated with a group of residents, described in this application. First, we will conduct a pilot test and process evaluation of the SMARxT program health IT intervention. Sixty family medicine and internal medicine residents from local training programs will be recruited to participate in the intervention and complete quantitative and qualitative assessments immediately after completion and 6 months later. These assessments will measure the residents' perceptions of feasibility and acceptability of the intervention. Additionally, specific process evaluation metrics will assess the implementation fidelity of the intervention. Second, the same 60 residents will participate in an outcome evaluation of the SMARxT program health IT intervention. This evaluation will be conducted concurrently with the process evaluation. A time-series quasi- experimental design-pre-test (T1), post-test (T2), and follow-up (T3)-will be employed, during which all residents will be asked to complete quantitative assessments. These assessments will measure the preliminary efficacy of the intervention in addressing the residents' knowledge and attitudes towards EBP as well as likely EBP behavior. The results from the pilot test and evaluation of the SMARxT program will allow us to make modifications and take steps to implement the program in other residency programs nationwide.
Medication prescriptions that are not evidence-based, meaning that they are not fully supported by scientific evidence, can lead to illness, injury, death, and rising health care costs. Pharmaceutical companies, which have been shown to influence physicians' prescribing behaviors through various marketing techniques, have begun to increase their presence in physicians' health IT environment, such as through smartphone and tablet applications. The goal of this project is to pilot test and evaluate a Web-based educational health information technology (HIT) program, called SMARxT, for medical residents that will teach them how to recognize and analyze pharmaceutical messages through health IT in order to make the best decisions about their patients' treatment options. In order to do this, we will pilot test and evaluate the SMARxT HIT intervention by conducting a series of surveys, focus groups and individual interviews with 60 first, second, and third-year residents from four residency programs.
