Group versus individual academic detailing to improve the use of antihypertensive medications in primary care: a cluster-randomized controlled trial.
OBJECTIVE
To compare group versus individual academic detailing to increase diuretic or beta-blocker use in hypertension.


METHODS
We conducted a cluster-randomized controlled trial in a large health maintenance organization. Subjects (N=9820) were patients with newly treated hypertension in the year preceding the intervention (N=3692), the 9 months following the intervention (N=3556), and the second year following intervention (N=2572). We randomly allocated 3 practice sites to group detailing (N=227 prescribers), 3 to individual detailing (N=235 prescribers), and 3 to usual care (N=319 prescribers). Individual detailing entailed a physician-educator meeting individually with clinicians to address barriers to prescribing guideline-recommended medications. The group detailing intervention incorporated the same social marketing principles in small groups of clinicians.


RESULTS
In the first year following the intervention, the rates of diuretic or beta-blocker use increased by 13.2% in the group detailing practices, 12.5% in the individual detailing practices, and 6.2% in the usual care practices. As compared with usual care practices, diuretic or beta-blocker use was more likely in group detailing practices (adjusted odds ratio (OR), 1.40; 95% confidence interval (CI), 1.11 - 1.76) and individual detailing practices (adjusted OR, 1.30; 95% CI, 0.95 - 1.79). Neither intervention affected blood pressure control. Two years following this single-visit intervention, there was still a trend suggesting a persistent effect of individual (OR, 1.22; 95% CI, 0.92 - 1.62), but not group, detailing (OR, 1.06; 95% CI, 0.80 - 1.39), as compared with usual care.


CONCLUSIONS
Both group and individual academic detailing improved antihypertensive prescribing over and above usual care but may require reinforcement to sustain improvements.
Simon
Steven R
SR
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue 6th Floor, Boston, MA 02215, USA. steven_simon@hms.harvard.edu
Majumdar
Sumit R
SR
Prosser
Lisa A
LA
Salem-Schatz
Susanne
S
Warner
Cheryl
C
Kleinman
Ken
K
Miroshnik
Irina
I
Soumerai
Stephen B
SB
D000319:Adrenergic beta-Antagonists / Q000191:economics; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004232:Diuretics / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D004363:Drug Utilization / Q000592:standards*; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006279:Health Maintenance Organizations / Q000592:standards*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009511:New England; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards; D040241:Social Marketing
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D004232:Diuretics