Guidelines and educational outreach visits from community pharmacists to improve prescribing in general practice: a randomised controlled trial.
OBJECTIVE
To evaluate the effectiveness of guidelines with or without one-to-one educational outreach visits by community pharmacists in improving general practice prescribing for non-steroidal anti-inflammatory drugs (NSAIDs).


METHODS
Cluster randomised trial of 20 general practices within Avon, England. Practices were randomised to three groups: control; mailed guidelines; mailed guidelines plus educational outreach visits. General practitioners (GPs) in the latter group received two one-to-one outreach visits from community pharmacists. Changes in prescribing were measured using outcomes derived from prescribing analysis and cost (PACT) data. The primary outcome measure was change in the volume of prescribing for ibuprofen, diclofenac and naproxen as a percentage of total NSAID prescribing. Six secondary outcomes included other measures of prescribing quality and volume. A cost-benefit analysis was performed.


RESULTS
No significant differences were observed for the primary outcome measure: practices receiving outreach visits prescribed only 2.1% [95% confidence interval (CI): -0.8 to 5.0] more of the three recommended NSAIDs than the control practices did and 1.6% (95% CI: -1.4 to 4.7) more than practices that received guidelines only. Following adjustment for multiple comparisons, only one secondary outcome showed a statistically significant difference between the groups: the proportion of prescribing of the five most frequently used drugs was 2.2% (95% CI: 0.9 to 3.6) higher in the educational outreach group compared with the control group. A net increase in costs was shown with both interventions.


CONCLUSIONS
Although good prescribing at baseline in the participating practices limited the capacity for improvement, this trial provides no evidence that guidelines with or without educational outreach visits from community pharmacists lead to substantial improvements in prescribing behaviour.
Watson
M
M
Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK.
Gunnell
D
D
Peters
T
T
Brookes
S
S
Sharp
D
D
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D011307:Drug Prescriptions / Q000191:economics / Q000592:standards*; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D005194:Family Practice / Q000592:standards*; D017408:Guidelines as Topic; D006801:Humans; D009140:Musculoskeletal Diseases / Q000188:drug therapy; D010594:Pharmacies / Q000458:organization & administration*; D010595:Pharmacists; D011785:Quality Assurance, Health Care; D006113:United Kingdom
D000894:Anti-Inflammatory Agents, Non-Steroidal