Abstract
Design: Randomised controlled simple blind trial, with randomisation into three groups: experimental (evidence based educational outreach visit), placebo (conventional education session), and control (without intervention).
Setting: The 24 primary care centres of the National Institute of Healthcare Network in a rural province of Aragon, Spain.
Participants: The 24 primary health care teams of the network, with 158 general practitioners (GPs). The teams were randomised into the groups, experimental (8 teams, 48 GPs), placebo (8 teams, 54 GPs), and control (8 teams, 56 GPs).
Intervention: Experimental group: one group educational outreach visit, conveying data based on a systematic review of the literature that was reinforced with printed material; placebo group: one non-structured educational session; control group: no intervention. Both educational sessions emphasised that there are no differences in the effectiveness of the NSAIDs reviewed (diclofenac, piroxicam, and tenoxicam); a recommendation was made to prescribe diclofenac over tenoxicam because of price differences.
Main outcome measures: Changes in the number of packages prescribed for each of the drugs and changes in the cost per package of NSAIDs prescribed during the six months before, and after the intervention.
Results: There were no differences in the basal characteristics of the three groups, except for the number of prescriptions during the six months before the intervention. Prescriptions for NSAIDs decreased homogeneously in the three groups. For tenoxicam, the experimental group reduced prescriptions by 22.5% (95%CI: 34.42 to -10.76), compared with a reduction of 9.78% (95%CI: -17.70 to -1.86) in the placebo group and an increase of 14.44% (95%CI: 5.22 to 23.66) in the control group. The average cost per prescription decreased by 1.91% (95%CI: -0.33% to -3.49%) in the experimental group, 0.16% (95%CI: -0.27% to -2.93%) in the placebo group, and rose by 1.76% (95%CI: 0.35% to 3.17%) in the control group.
Conclusions: Evidence based educational outreach visits are more effective than no intervention at all. Results suggest that evidence based educational outreach visits are incrementally more effective than conventional educational sessions, which in turn are more effective than no intervention at all.
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Selected References
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- Avorn J., Soumerai S. B., Everitt D. E., Ross-Degnan D., Beers M. H., Sherman D., Salem-Schatz S. R., Fields D. A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. N Engl J Med. 1992 Jul 16;327(3):168–173. doi: 10.1056/NEJM199207163270306. [DOI] [PubMed] [Google Scholar]
- Davis D. A., Thomson M. A., Oxman A. D., Haynes R. B. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995 Sep 6;274(9):700–705. doi: 10.1001/jama.274.9.700. [DOI] [PubMed] [Google Scholar]
- Davis D. A., Thomson M. A., Oxman A. D., Haynes R. B. Evidence for the effectiveness of CME. A review of 50 randomized controlled trials. JAMA. 1992 Sep 2;268(9):1111–1117. [PubMed] [Google Scholar]
- Diwan V. K., Wahlström R., Tomson G., Beermann B., Sterky G., Eriksson B. Effects of "group detailing" on the prescribing of lipid-lowering drugs: a randomized controlled trial in Swedish primary care. J Clin Epidemiol. 1995 May;48(5):705–711. doi: 10.1016/0895-4356(94)00221-b. [DOI] [PubMed] [Google Scholar]
- Figueiras A., Sastre I., Tato F., Rodríguez C., Lado E., Caamaño F., Gestal-Otero J. J. One-to-one versus group sessions to improve prescription in primary care: a pragmatic randomized controlled trial. Med Care. 2001 Feb;39(2):158–167. doi: 10.1097/00005650-200102000-00006. [DOI] [PubMed] [Google Scholar]
- Greco P. J., Eisenberg J. M. Changing physicians' practices. N Engl J Med. 1993 Oct 21;329(17):1271–1273. doi: 10.1056/NEJM199310213291714. [DOI] [PubMed] [Google Scholar]
- Mugford M., Banfield P., O'Hanlon M. Effects of feedback of information on clinical practice: a review. BMJ. 1991 Aug 17;303(6799):398–402. doi: 10.1136/bmj.303.6799.398. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Oxman A. D., Thomson M. A., Davis D. A., Haynes R. B. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ. 1995 Nov 15;153(10):1423–1431. [PMC free article] [PubMed] [Google Scholar]
- Riedemann P. J., Bersinic S., Cuddy L. J., Torrance G. W., Tugwell P. X. A study to determine the efficacy and safety of tenoxicam versus piroxicam, diclofenac and indomethacin in patients with osteoarthritis: a meta-analysis. J Rheumatol. 1993 Dec;20(12):2095–2103. [PubMed] [Google Scholar]
- Robertson N., Baker R., Hearnshaw H. Changing the clinical behavior of doctors: a psychological framework. Qual Health Care. 1996 Mar;5(1):51–54. doi: 10.1136/qshc.5.1.51. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Santoso B., Suryawati S., Prawaitasari J. E. Small group intervention vs formal seminar for improving appropriate drug use. Soc Sci Med. 1996 Apr;42(8):1163–1168. doi: 10.1016/0277-9536(95)00390-8. [DOI] [PubMed] [Google Scholar]
- Schectman J. M., Kanwal N. K., Schroth W. S., Elinsky E. G. The effect of an education and feedback intervention on group-model and network-model health maintenance organization physician prescribing behavior. Med Care. 1995 Feb;33(2):139–144. [PubMed] [Google Scholar]
- Soumerai S. B., Avorn J. Principles of educational outreach ('academic detailing') to improve clinical decision making. JAMA. 1990 Jan 26;263(4):549–556. [PubMed] [Google Scholar]
- Soumerai S. B., McLaughlin T. J., Avorn J. Improving drug prescribing in primary care: a critical analysis of the experimental literature. Milbank Q. 1989;67(2):268–317. [PubMed] [Google Scholar]