Physicians in the intervention group were mailed a written feedback letter regarding their patients who were prescribed questionable metoclopramide therapy. Non-intervention providers received no letter. The letter consisted of the following components:

1. The name and medical record # of the patients involved
2. Information regarding the metoclopramide prescription: dates, dosage, indication recorded, and the duration of therapy
3. A reminder of the adverse effect of long-term metoclopramide therapy
4. A recommendation to consider having the patient undergo a trial of metoclopramide discontinuation if appropriate, and documentation of a discussion of risk and benefits of metoclopramide therapy with patients
5. A request that the physician document the discontinuation trial in the electronic medical record

No intervention letters were sent to subjects in this arm

Physicians in the intervention group were mailed a written feedback letter regarding their patients who were prescribed questionable metoclopramide therapy. Non-intervention providers received no letter. The letter consisted of the following components:

1. The name and medical record # of the patients involved
2. Information regarding the metoclopramide prescription: dates, dosage, indication recorded, and the duration of therapy
3. A reminder of the adverse effect of long-term metoclopramide therapy
4. A recommendation to consider having the patient undergo a trial of metoclopramide discontinuation if appropriate, and documentation of a discussion of risk and benefits of metoclopramide therapy with patients
5. A request that the physician document the discontinuation trial in the electronic medical record

Twelve weeks after the intervention period, we searched the medical records of patients in the intervention and non-intervention groups to determine whether discontinuation of metoclopramide therapy had taken place.