An open cluster-randomized, 18-month trial to compare the effectiveness of educational outreach visits with usual guideline dissemination to improve family physician prescribing

Implementation Science

Pedro A Caetano²  Isabel Santos²  Ana Luísa Papoila²  David S Rodrigues²  Bruno Heleno¹  Daniel Pinto² 

[1] The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postbox 2099, 1014 Copenhagen K, Denmark;Nova Medical School (Faculdade de Ciências Médicas-Universidade Nova de Lisboa), CEDOC, GIAI, Campo dos Mártires da Pátria 130, 1169-056 Lisbon, Portugal

关键词: Cost-benefit analysis;    Program evaluation;    Drug utilization;    Family practice;    Guideline adherence;    Academic detailing;    Educational outreach;   

Others  :  810533
DOI  :  10.1186/1748-5908-9-10

 received in 2013-11-24, accepted in 2014-01-11,  发布年份 2014

【 摘 要 】

Background

The Portuguese National Health Directorate has issued clinical practice guidelines on prescription of anti-inflammatory drugs, acid suppressive therapy, and antiplatelets. However, their effectiveness in changing actual practice is unknown.

Methods

The study will compare the effectiveness of educational outreach visits regarding the improvement of compliance with clinical guidelines in primary care against usual dissemination strategies. A cost-benefit analysis will also be conducted. We will carry out a parallel, open, superiority, randomized trial directed to primary care physicians. Physicians will be recruited and allocated at a cluster-level (primary care unit) by minimization. Data will be analyzed at the physician level. Primary care units will be eligible if they use electronic prescribing and have at least four physicians willing to participate. Physicians in intervention units will be offered individual educational outreach visits (one for each guideline) at their workplace during a six-month period. Physicians in the control group will be offered a single unrelated group training session. Primary outcomes will be the proportion of cyclooxygenase-2 inhibitors prescribed in the anti-inflammatory class, and the proportion of omeprazole in the proton pump inhibitors class at 18 months post-intervention. Prescription data will be collected from the regional pharmacy claims database. We estimated a sample size of 110 physicians in each group, corresponding to 19 clusters with a mean size of 6 physicians. Outcome collection and data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and detailers cannot be blinded.

Discussion

This trial will attempt to address unresolved issues in the literature, namely, long term persistence of effect, the importance of sequential visits in an outreach program, and cost issues. If successful, this trial may be the cornerstone for deploying large scale educational outreach programs within the Portuguese National Health Service.

Trial registration

ClinicalTrials.gov number NCT01984034.

【 授权许可】

   
2014 Pinto et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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