A randomised controlled trial of the effect of educational outreach by community pharmacists on prescribing in UK general practice.
BACKGROUND
Educational outreach visits are commonly used to promote changes in prescribing in family practice. However, the effectiveness of outreach visits has not been evaluated across a range of settings.


OBJECTIVE
To estimate the effectiveness of educational outreach visits on United Kingdom (UK) general practice prescribing and to examine the extent to which practice characteristics influenced outcome.


METHODS
Randomised controlled trial.


METHODS
General practices in 12 health authorities in England.


METHODS
Educational outreach visits were made to practices that received two of four guidelines. Each practice provided data on treatment of patients for all four guidelines for both pre and post-intervention periods. The primary outcome is average effect across all four guidelines. Secondary analyses examined the predictive effect of practice and guideline characteristics.


RESULTS
Seventy per cent of practices approached agreed to take part in the intervention. Overall, educational outreach was associated with a significant improvement in prescribing practice (odds ratio [OR] = 1.24 [95% CI = 1.07 to 1.42]), a 5.2% (95% CI = 1.7% to 8.7%) increase in the number of patients treated within the guideline recommendations. Smaller practices (two or fewer full-time equivalent practitioners) responded much more favourably to educational outreach than larger practices. Smaller practices improved their performance in line with the guidelines by 13.5% (95% CI = 6% to 20.9%) attributable to outreach, while larger practices improved by only 1.4% (95% CI = -2.4% to 5.3%, P-value for interaction <0.001).


CONCLUSIONS
In large practices, educational outreach alone is unlikely to achieve worthwhile change. There is good evidence to support the use of educational outreach visits in small practices.
Freemantle
Nick
N
Department of Primary Care and General Practice, The Medical School, University of Birmingham, Edgbaston. N.Freemantle@bham.ac.uk
Nazareth
Irwin
I
Eccles
Martin
M
Wood
John
J
Haines
Andrew
A
D003157:Community Pharmacy Services / Q000458:organization & administration* / Q000592:standards; D003159:Community-Institutional Relations; D004363:Drug Utilization / Q000592:standards*; D004502:Education, Medical, Continuing / Q000379:methods; D004739:England; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000193:education* / Q000592:standards; D006801:Humans; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D013222:State Medicine