Kim 1999
| Methods | Purpose: to compare the effect of providing education, peer‐comparison feedback and academic detailing to physicians with providing education to physicians, on the number of preventive services and the % of participants to which they were offered Design: RCT, physicians randomised to the 2 interventions Duration of study: 2.5 years Interval between intervention and when outcome was measured: February 1992 to February 1994 Power computation: not performed Statistics: mixed model ANOVA, participants nested within physicians | |
| Participants | Country: USA Setting: Kaiser Permanente Woodland Hills HMO San Fernando Valley, California Eligible participants: (health status) 48 family physicians, internists and sub‐specialists providing primary care for at least 60 participants (of whom 7 dropped out leaving 41); 9233 participants were 65 to 75 and eligible; surveys mailed to a random sample of 3249, of whom 2237 completed baseline and follow‐up surveys, 299 then excluded as their physician left the group, sample = 1810 participants Age: avg 73 Gender: participants 50% f | |
| Interventions | Intervention 1: mailed educational materials about 7 preventive care services Intervention 2: same as 1 + anonymous 15 minutes academic detailing and peer‐comparison feedback from pharmacist at beginning of study and 6 and 12 months later Control: no control group | |
| Outcomes | Outcome measured: % vaccinated; measured by chart review and patient survey (23% to 26% over‐estimation by participants compared to chart review) Time points from the study that are considered in the review or measured or reported in the study: surveys of participants January to May 1992, and December 1995 to January 1996 Vaccinated by: January 1996 | |
| Notes | Funding: Sidney Garfield Memorial Fund, S Kaiser Permanente | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | "... physicians were randomly assigned" (no statement about method) |
| Allocation concealment (selection bias) | Unclear risk | No statement |
| Blinding (performance bias and detection bias) All outcomes | Low risk | No statement, but chart review by 4 trained personnel using standardised forms, interrater reliability = 100% |
| Incomplete outcome data (attrition bias) All outcomes | High risk | 2337 participants completed both baseline and follow‐up surveys, but outcomes for the 7 physicians who dropped out and their 128 participants, and a further 299 participants because their physician was not part of the group, are not presented; and final outcome data are presented only for 1810 participants |
| Selective reporting (reporting bias) | Low risk | No selective reporting |