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 |