Rational Prescribing in Primary Care (RaPP-trial). A randomised trial of a tailored intervention to improve prescribing of antihypertensive and cholesterol-lowering drugs in general practice [ISRCTN48751230].
BACKGROUND
The underlying reasons for differences between clinical practice and systematically developed guidelines vary from one clinical problem to another. It is therefore logical to tailor strategies to support the implementation of guidelines to address identified barriers to change. The objective of this trial is to evaluate the effects of a tailored intervention to support the implementation of systematically developed guidelines for the use of antihypertensive and cholesterol-lowering drugs for the primary prevention of cardiovascular disease.


METHODS
Unblinded, cluster-randomised trial. 150 general practices will be recruited from two geographical areas in Norway, and randomised to the intervention or control group (passive dissemination of guidelines). Outcomes will be measured for all eligible patients seen in the participating practices during one year after the intervention. A multifaceted intervention has been tailored to address identified barriers to change. Key components are an educational outreach visit with audit and feedback, and computerised reminders. Pharmacists will conduct the visits. During the outreach visit the main recommendations will be presented and software will be installed that links to the electronic medical record systems used in the participating practices. The software will perform an audit that will be fed back during the visit, present pop-up reminders for patients with high blood pressure or cholesterol, and provide a cardiovascular risk calculator and patient education material. The main outcomes are the proportions of 1) first time prescriptions for hypertension where thiazides are not prescribed, 2) patients not assessed for cardiovascular risk before prescribing antihypertensive or cholesterol-lowering drugs, and 3) patients treated for hypertension or high cholesterol for three months or more who have not achieved recommended treatment goals.
Fretheim
Atle
A
Department of Health Services Research, Norwegian Directorate for Health and Social Affairs, N-0031 Oslo, Norway. atle.fretheim@shdir.no
Oxman
Andrew D
AD
Treweek
Shaun
S
Bjørndal
Arild
A
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001581:Benzothiadiazines; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D004232:Diuretics; D004363:Drug Utilization / Q000706:statistics & numerical data; D004502:Education, Medical, Continuing; D005194:Family Practice / Q000193:education / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D008485:Medical Audit; D009664:Norway; D010043:Outcome and Process Assessment, Health Care; D010595:Pharmacists; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011322:Primary Prevention / Q000592:standards*; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use
D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D001581:Benzothiadiazines; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors