Impact of a general practitioner educational intervention on osteoarthritis treatment in an elderly population.
OBJECTIVE
We examined whether a continuing medical education intervention increased general practitioners' ability to select the proper pharmacological treatment for patients with osteoarthritis.


METHODS
Eight towns in Quebec, Canada were randomly allocated to one of four intervention options, workshop and decision tree, workshop, decision tree, or no intervention. All general practitioners practicing in each town were eligible to participate. We evaluated all dispensed prescriptions for either a cyclooxygenase (COX)-2 inhibitor, nonselective nonsteroidal anti-inflammatory drug or acetaminophen written by eligible general practitioners between May 2000 and June 2001 to elderly patients suffering from osteoarthritis. We used a multi-level Bayesian hierarchical model to assess the impact of the interventions on prescription adequacy.


RESULTS
We analyzed 5318 dispensed prescriptions written by 249 general practitioners in the five-month preintervention period and 4610 dispensed prescriptions written by the same physicians in the five-month postintervention period. A score of zero or one was given to every prescription, with one indicating prescription adequacy according to guidelines provided during the interventions. Bayesian hierarchical models showed some improvement in scores in the post- versus preintervention periods in all four groups. The probability of an improvement in the towns allocated the workshop and decision tree over the control was 94%, compared with 74% in the workshop group and 55% in the decision tree group.


CONCLUSIONS
An interactive approach offered by peers and complemented by easy to use guidelines may enhance the general practitioner's ability to manage osteoarthritis patients.
Rahme
Elham
E
Department of Medicine, McGill University, Montreal, Canada. elham.rahme@mcgill.ca
Choquette
Denis
D
Beaulieu
Michele
M
Bessette
Louis
L
Joseph
Lawrence
L
Toubouti
Youssef
Y
LeLorier
Jacques
J
D000082:Acetaminophen / Q000191:economics / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use; D001499:Bayes Theorem; D052246:Cyclooxygenase 2 Inhibitors / Q000191:economics / Q000627:therapeutic use; D003663:Decision Trees; D016527:Drug Costs; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data; D004493:Education; D004502:Education, Medical, Continuing / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D010003:Osteoarthritis / Q000188:drug therapy* / Q000191:economics; D010437:Peptic Ulcer / Q000139:chemically induced / Q000517:prevention & control; D010821:Physicians, Family / Q000523:psychology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011792:Quebec; D012189:Retrospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D052246:Cyclooxygenase 2 Inhibitors; D000082:Acetaminophen