Improving prescribing of antihypertensive and cholesterol-lowering drugs: a method for identifying and addressing barriers to change.
BACKGROUND
We describe a simple approach we used to identify barriers and tailor an intervention to improve pharmacological management of hypertension and hypercholesterolaemia. We also report the results of a post hoc exercise and survey we carried out to evaluate our approach for identifying barriers and tailoring interventions.


METHODS
We used structured reflection, searched for other relevant trials, surveyed general practitioners and talked with physicians during pilot testing of the intervention. The post hoc exercise was carried out as focus groups of international researchers in the field of quality improvement in health care. The post hoc survey was done by telephone interviews with physicians allocated to the experimental group of a randomised trial of our multifaceted intervention.


RESULTS
A wide range of barriers was identified and several interventions were suggested through structured reflection. The survey led to some adjustments. Studying other trials and pilot testing did not lead to changes in the design of the intervention. Neither the post hoc focus groups nor the post hoc survey revealed important barriers or interventions that we had not considered or included in our tailored intervention.


CONCLUSIONS
A simple approach to identifying barriers to change appears to have been adequate and efficient. However, we do not know for certain what we would have gained by using more comprehensive methods and we do not know whether the resulting intervention would have been more effective if we had used other methods. The effectiveness of our multifaceted intervention is under evaluation in a randomised controlled trial.
Fretheim
Atle
A
Informed Choice Research Department, Norwegian Health Services Research Centre, P,O, Box 7004, St, Olavs plass, Oslo, Norway. atle.fretheim@nhsrc.no
Oxman
Andrew D
AD
Flottorp
Signe
S
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001581:Benzothiadiazines; D004232:Diuretics; D004363:Drug Utilization / Q000592:standards* / Q000706:statistics & numerical data; D004502:Education, Medical, Continuing; D005194:Family Practice / Q000193:education* / Q000592:standards; D019983:Guideline Adherence; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D006973:Hypertension / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards; D018570:Risk Assessment; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use
D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D001581:Benzothiadiazines; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors