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. 2005 Aug;14(4):258–263. doi: 10.1136/qshc.2004.012617

A trial of education, prompts, and opinion leaders to improve prescription of lipid modifying therapy by primary care physicians for patients with ischemic heart disease

H Bloomfield 1, D Nelson 1, M van Ryn 1, B Neil 1, N Koets 1, J Basile 1, F Samaha 1, R Kaul 1, J Mehta 1, D Bouland 1
PMCID: PMC1744060  PMID: 16076789

Abstract

Background: Recent clinical trials indicate that treatment with lipid modifying therapy improves outcomes in patients with ischemic heart disease (IHD) and low levels of high density lipoprotein (HDL) cholesterol. The results of these trials, however, have not been widely implemented in clinical practice.

Objectives: To develop and test an intervention designed to increase the rate of prescription of lipid modifying therapy and to determine the relative effectiveness of three different prompts (progress notes, patient letters, or computer chart reminders).

Methods: The study was conducted in 11 US Department of Veterans Affairs Medical Centers. The effect of the intervention on the proportion of eligible patients receiving lipid modifying therapy was compared between five intervention sites and six matched control sites using a controlled before and after study design. Additionally, 92 providers within the intervention clinics were randomized to receive one of the three prompts. Data were analyzed using logistic regression modeling which incorporated terms to account for the clustered nature of the data.

Results: At the intervention sites the prescription rate increased from 8.3% during the pre-intervention period to 39.1% during the intervention (OR = 6.5, 95% CI 5.2 to 8.2, p<0.0001) but remained unchanged at the control sites. The interaction between group (control v intervention) and time period was highly significant (p<0.0001). The adjusted odds of receiving a prescription during the intervention period was 3.1 times higher at the intervention sites than at the control sites (95% CI 2.1 to 4.7). Overall, there was no significant difference in prescription rates among the three prompt groups. However, there was a significant interaction between prompt group and site, indicating that the efficacy of the prompts differed by site.

Conclusion: An intervention for primary care providers consisting of an educational workshop, opinion leader influence, and prompts substantially increased the prescription rate of lipid modifying therapy.

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Selected References

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  1. Balas E. A., Weingarten S., Garb C. T., Blumenthal D., Boren S. A., Brown G. D. Improving preventive care by prompting physicians. Arch Intern Med. 2000 Feb 14;160(3):301–308. doi: 10.1001/archinte.160.3.301. [DOI] [PubMed] [Google Scholar]
  2. Cabana M. D., Rand C. S., Powe N. R., Wu A. W., Wilson M. H., Abboud P. A., Rubin H. R. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999 Oct 20;282(15):1458–1465. doi: 10.1001/jama.282.15.1458. [DOI] [PubMed] [Google Scholar]
  3. Carter W. B., Inui T. S., Kukull W. A., Haigh V. H. Outcome-based doctor-patient interaction analysis: II. Identifying effective provider and patient behavior. Med Care. 1982 Jun;20(6):550–566. doi: 10.1097/00005650-198206000-00002. [DOI] [PubMed] [Google Scholar]
  4. Demakis J. G., Beauchamp C., Cull W. L., Denwood R., Eisen S. A., Lofgren R., Nichol K., Woolliscroft J., Henderson W. G. Improving residents' compliance with standards of ambulatory care: results from the VA Cooperative Study on Computerized Reminders. JAMA. 2000 Sep 20;284(11):1411–1416. doi: 10.1001/jama.284.11.1411. [DOI] [PubMed] [Google Scholar]
  5. Eccles M., Grimshaw J., Campbell M., Ramsay C. Research designs for studies evaluating the effectiveness of change and improvement strategies. Qual Saf Health Care. 2003 Feb;12(1):47–52. doi: 10.1136/qhc.12.1.47. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Grimshaw Jeremy M., Eccles Martin P., Walker Anne E., Thomas Ruth E. Changing physicians' behavior: what works and thoughts on getting more things to work. J Contin Educ Health Prof. 2002 Fall;22(4):237–243. doi: 10.1002/chp.1340220408. [DOI] [PubMed] [Google Scholar]
  7. Haines A., Donald A. Making better use of research findings. BMJ. 1998 Jul 4;317(7150):72–75. doi: 10.1136/bmj.317.7150.72. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hulscher M. E. J. L., Laurant M. G. H., Grol R. P. T. M. Process evaluation on quality improvement interventions. Qual Saf Health Care. 2003 Feb;12(1):40–46. doi: 10.1136/qhc.12.1.40. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. 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]
  10. Rubins H. B., Robins S. J., Collins D., Fye C. L., Anderson J. W., Elam M. B., Faas F. H., Linares E., Schaefer E. J., Schectman G. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med. 1999 Aug 5;341(6):410–418. doi: 10.1056/NEJM199908053410604. [DOI] [PubMed] [Google Scholar]
  11. Sanson-Fisher Robert W., Grimshaw Jeremy M., Eccles Martin P. The science of changing providers' behaviour: the missing link in evidence-based practice. Med J Aust. 2004 Mar 1;180(5):205–206. doi: 10.5694/j.1326-5377.2004.tb05884.x. [DOI] [PubMed] [Google Scholar]
  12. Shea S., DuMouchel W., Bahamonde L. A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. J Am Med Inform Assoc. 1996 Nov-Dec;3(6):399–409. doi: 10.1136/jamia.1996.97084513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Sloan K. L., Sales A. E., Willems J. P., Every N. R., Martin G. V., Sun H., Pineros S., Sharp N. Frequency of serum low-density lipoprotein cholesterol measurement and frequency of results < or=100 mg/dl among patients who had coronary events (Northwest VA Network Study). Am J Cardiol. 2001 Nov 15;88(10):1143–1146. doi: 10.1016/s0002-9149(01)02050-1. [DOI] [PubMed] [Google Scholar]
  14. Turner B. J., Day S. C., Borenstein B. A controlled trial to improve delivery of preventive care: physician or patient reminders? J Gen Intern Med. 1989 Sep-Oct;4(5):403–409. doi: 10.1007/BF02599691. [DOI] [PubMed] [Google Scholar]

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