Zwarenstein 2007.
| Trial name or title | The OPEM trial to narrow the evidence‐practice gap with respect to prescribing practices of general and family physicians: a C‐RCT, targeting the care of individuals with diabetes and hypertension in Ontario, Canada |
| Methods | Study design: C‐RCT Unit of allocation: practices Type of comparison: PEM only vs. nothing
Groups considered in review: A and D |
| Participants | Physicians Clinical speciality: general practice/family medicine Level of training: not clear |
| Interventions | The authors aim to conduct 3 replicates of the trial to cover the 3 evidence‐practice gaps over a 9‐month period (3 successive mail outs of informed). They plan to test the effects of short (directive) and long (discursive) PEMs compared with no PEM on the clinical practices of primary care physicians, and on related patient outcomes. In the first replicate (ACE inhibitors, hypertension treatment, and cholesterol‐lowering agents for diabetes), the first intervention group will receive a copy of informed with both the short, directive, evidence‐based outsert stapled to the lower‐left quarter of the front page, and the longer 2‐page insert focusing on the same topic as the outsert. The second intervention group will receive the identical informed, with only the above‐mentioned outsert. The third intervention group will receive the identical copy of informed with the above‐mentioned insert. The control group will receive the identical informed only, without the insert or the outsert. The healthcare topic shared by the insert and outsert will not be covered elsewhere in that issue of informed. For the second replicate (retinal screening in patients with diabetes), in addition to the short, directive outsert and the longer, explanatory insert, a reminder note will be added that physicians could give to their patients to supplement the verbal reminder that physicians are encouraged to give. Because it is not clear whether this patient‐held reminder to make an appointment with their eye‐care provider is any more effective than the verbal reminder that physicians will be encouraged to give, those physicians receiving an outsert to receive a pad of the patient‐aimed reminder slips will be randomised. For the third replicate (using thiazides as first‐line treatment for hypertension), 2 different short directive outsert messages will be used (in addition to the long, explanatory insert message). The OPEM team will develop the first outsert message, whereas a team of psychologists with experience in knowledge implementation and the use of psychological theories will develop the second outsert message. With the addition of a theory‐based outsert, it will be possible to determine whether a message that is based on psychological theory, specifically on the Theory of Planned Behaviour, will be more effective in changing clinical behaviour towards more evidence‐based practice than a message that is based on 'standard' methods, which are uninformed by an explicit theoretical basis |
| Outcomes |
|
| Starting date | |
| Contact information | Merrick Zwarenstein Institute for Clinical Evaluative Sciences, Toronto, Canada Email: merrick.zwarenstein@ices.on.ca |
| Notes |
ACE: angiotensin‐converting enzyme; ALLHAT: Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial; C‐RCT: cluster randomised controlled trial; HDL: high‐density lipoprotein; ITS: interrupted time series; LDL: low‐density lipoprotein; ODB: Ontario's universal Drug Benefit; OPEM: Ontario Printed Educational Message; PEM: printed educational material.