Improving adherence to dementia guidelines through education and opinion leaders. A randomized, controlled trial.
BACKGROUND
Educational methods that encourage physicians to adopt practice guidelines are needed.


OBJECTIVE
To evaluate an educational strategy to increase neurologists' adherence to specialty society-endorsed practice recommendations.


METHODS
Randomized, controlled trial.


METHODS
Six urban regions in New York State.


METHODS
417 neurologists.


METHODS
The educational strategy promoted six recommendations for evaluation and management of dementia. It included a mailed American Academy of Neurology continuing medical education course, practice-based tools, an interactive evidence-based American Academy of Neurology-sponsored seminar led by local opinion leaders, and follow-up mailings.


METHODS
Neurologists' adherence to guidelines was measured by using detailed clinical scenarios mailed to a baseline group 3 months before the intervention and to intervention and control groups 6 months after the intervention. In one region, patients' medical records were reviewed to determine concordance between neurologists' scenario responses and their actual care.


RESULTS
Compared with neurologists in the baseline and control groups, neurologists in the intervention group were more adherent to three of the six recommendations: neuroimaging for patients with dementia only when certain criteria are present (odds ratio, 4.1 [95% CI, 1.9 to 8.9]), referral of all patients with dementia and their families to the Alzheimer's Association (odds ratio, 2.8 [CI, 1.7 to 4.8]), and encouragement of all patients and their families to enroll in the Alzheimer's Association Safe Return Program (odds ratio, 10.8 [CI, 3.5 to 33.2]). For the other three recommendations, adherence did not differ between the intervention and the nonintervention groups. Agreement between scenario responses and actual care ranged from 27% to 99% for the six recommendations and was 95% or more for three of the recommendations.


CONCLUSIONS
A multifaceted educational program can improve physician adoption of practice guidelines.
Gifford
D R
DR
Brown University School of Medicine, Providence, Rhode Island, USA. David_Gifford@brown.edu
Holloway
R G
RG
Frankel
M R
MR
Albright
C L
CL
Meyerson
R
R
Griggs
R C
RC
Vickrey
B G
BG
D003704:Dementia / Q000517:prevention & control*; D004493:Education; D004502:Education, Medical, Continuing; D018961:Educational Technology; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D009462:Neurology / Q000193:education*; D017410:Practice Guidelines as Topic