One-to-one versus group sessions to improve prescription in primary care: a pragmatic randomized controlled trial.
OBJECTIVE
The objective of the study was to evaluate the effectiveness of 2 educational strategies aimed at improving prescribing standards in primary care.


METHODS
A pragmatic controlled trial was designed; the study population included general and family practitioners in Galicia (northwestern Spain) divided into 3 study groups: a one-to-one education group (n = 98), a by-group education group (n = 92), and a control group (n = 405). The educational intervention included explicit recommendations for selecting nonsteroidal anti-inflammatory drugs (NSAIDs) for inflammation signs. Some of the subjects were given reminders. Mixed-effect linear models were applied to data analysis. Analyses were done by intention-to-treat. The dependent variable is a rate with a numerator that is the number of prescribed units of the NSAIDs recommended during intervention; the denominator is the total number of prescribed units of the NSAID total.


RESULTS
One-to-one education obtained an average prescribing behavior improvement of 6.5% (P < 0.001) in the 9 months after intervention. In the education group, the average improvement was 2.4% (P < 0.05) for the same period. Statistically significant differences were observed between the group intervention and one-to-one groups. The reminder increased significantly the effectiveness of the one-to-one intervention.


CONCLUSIONS
A single, short educational session to primary care doctors can improve their prescribing standards during long periods of > or = 9 months. Of the 2 strategies followed in the trial, one-to-one education has shown to be the most effective. Results also show that the effectiveness of these interventions increases when presented together with written material.
Figueiras
A
A
Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Spain.
Sastre
I
I
Tato
F
F
Rodríguez
C
C
Lado
E
E
Caamaño
F
F
Gestal-Otero
J J
JJ
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000592:standards; D004363:Drug Utilization / Q000592:standards*; D004502:Education, Medical, Continuing / Q000379:methods*; D006126:Group Processes; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010821:Physicians, Family / Q000193:education* / Q000523:psychology; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D013030:Spain; D013663:Teaching / Q000379:methods*; D013664:Teaching Materials; D013997:Time Factors; D017749:Total Quality Management / Q000458:organization & administration*
D000894:Anti-Inflammatory Agents, Non-Steroidal