The influence of mortality trials on the evolution of clinical practice.
Clinical practice is complex and is influenced by a number of factors such as time since medical qualification, opportunities for further education and peer review, as well as trial results and marketing. Systematic audit and peer review are powerful tools that are being used increasingly. When aided by the intelligent, but not Draconian, use of financial carrots they are an effective means of changing practice. Positive trials, such as those of thrombolytic therapy, have rapidly resulted in the widespread use of such treatment. Negative trials, for example those involving anti-arrhythmic prophylaxis after myocardial infarction or the use of calcium antagonists in patients with impaired left ventricular function, have also correctly resulted in an appropriate change in practice. Advertising does not always reflect best clinical practice and could lead to under-promotion of older but more useful drugs. Peer review and audit are probably the best available methods for promoting good clinical practice.
Sleight
P
P
John Radcliffe Hospital, University of Oxford, UK.
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000401:mortality*; D002986:Clinical Trials as Topic; D006801:Humans; D015201:Meta-Analysis as Topic; D015337:Multicenter Studies as Topic; D010818:Practice Patterns, Physicians'; D015912:Thrombolytic Therapy
D000806:Angiotensin-Converting Enzyme Inhibitors