Determining educational needs in the physician's office.

Techniques to identify educational needs from real events in office practice are usually unwieldy, intrusive, and expensive. We are developing an approach based on review and analysis of individual physicians' prescriptions. This technique imposes little additional effort on the participating physician, yet effectively identifies problems in drug prescribing that can lead to specific educational remedies. Experience with 44 physicians using the system shows wide variation in prescribing practices as well as in the needs identified. The problems can be grouped into seven major categories: inappropriate indications; excessively frequent prescriptions for certain drugs; prescription of drugs with abuse potential; inadequate instructions; excessive dosage, especially in elderly patients; prescription of ineffective drugs; and potential drug interactions. The method offers promise as a component of an individualized guidance system linking continuing medical education with actual medical practice.