title: Academic detailing to improve antihypertensive prescribing patterns.
abstract: Several studies indicate that treatment of hypertension in the United States does not follow recommendations from expert bodies. We thus implemented a program using academic detailers to increase practitioner compliance with antihypertensive treatment guidelines. Five Veterans Affairs medical facilities including academic medical centers and community based outpatient clinics were chosen for the intervention. Pharmacists were trained as academic detailers, and the intervention included lectures, educational materials, provider profiling, and meetings with 25 to 50 providers each. After intervention, the proportion of hypertensives receiving calcium antagonists decreased from 43% to 38% (P <.001), whereas the proportion receiving a beta blocker or thiazide diuretic increased from 58% to 64% (P <.001). For hypertensive subjects with diabetes mellitus or congestive heart failure, the proportion receiving an angiotensin converting enzyme inhibitor or angiotensin receptor blocker increased from 72% to 76% for the former and from 74% to 78% for the latter (P <.001 for both). Among hypertensive subjects with coronary artery disease an increase in beta blocker use was noted after intervention (P <.001 for change from baseline). Prescribing patterns after academic detailing more closely followed national recommendations.
authors.affiliation: Medical Service, Department of Veterans Affairs, Northern California Health Care System, Mather, California 95655, USA. david.siegel@med.va.gov
authors.forename: David
authors.initials: D
authors.lastname: Siegel
authors.forename: Julio
authors.initials: J
authors.lastname: Lopez
authors.forename: Joy
authors.initials: J
authors.lastname: Meier
authors.forename: Mary K
authors.initials: MK
authors.lastname: Goldstein
authors.forename: Samuel
authors.initials: S
authors.lastname: Lee
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Brazill
authors.forename: Mazen S
authors.initials: MS
authors.lastname: Matalka
mesh_terms: D000046:Academic Medical Centers; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D010595:Pharmacists; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D000959:Antihypertensive Agents