Is untargeted outreach visiting in primary care effective? A pragmatic randomized controlled trial.
BACKGROUND
There is increasing evidence that clinical guidelines can lead to improvements in clinical care. However, they are not self-implementing. Outreach visits may improve prescribing behaviour.


METHODS
Within a before-and-after pragmatic randomized controlled trial, involving all general practices in one health district, routine methods were used to distribute guidelines for management of Helicobacter pylori eradication. Intervention practices were offered a visit and the conduct of an audit by a pharmacist trained in the techniques of outreach visiting. The intervention was evaluated using level three Prescribing Analysis and Cost (PACT) data for metronidazole and omeprazole for the two 12 month periods around the introduction of the guidelines.


RESULTS
Of the 38 intervention practices 19 accepted an outreach visit and three accepted the offer of an audit. There was a significant increase in omeprazole use during the study of 0.24 [95 per cent confidence interval (CI) +0.19 to +0.29] dose units per year but no effect from the offer [-0.02 (95 per cent CI -0.12 to +0.08) dose units] or acceptance of a visit [-0.03 (95 per cent CI -0.15 to +0.08) dose units]. The results for metronidazole were similar, with an increase in use of 0.028 (95 per cent CI +0.018 to +0.038) dose units per year. The effect of the intervention was a non-significant change in prescribing of -0.005 (95 per cent CI -0.025 to +0.015) dose units. Accepting a visit had little effect on prescribing: a change of 0.003 (95 per cent CI -0.021 to +0.027) dose units.


CONCLUSIONS
The routine use of untargeted outreach visiting is probably not a worthwhile strategy.
Hall
L
L
Centre for Health Services Research, University of Newcastle upon Tyne.
Eccles
M
M
Barton
R
R
Steen
N
N
Campbell
M
M
D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D003157:Community Pharmacy Services / Q000592:standards*; D003159:Community-Institutional Relations / Q000592:standards*; D011307:Drug Prescriptions / Q000592:standards*; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D004739:England; D005194:Family Practice / Q000193:education* / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008485:Medical Audit; D008795:Metronidazole / Q000627:therapeutic use; D009853:Omeprazole / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D015397:Program Evaluation; D054328:Proton Pump Inhibitors
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D010406:Penicillins; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D009853:Omeprazole