title: Investigation of the effect of a countywide protected learning time scheme on prescribing rates of ramipril: interrupted time series study.
abstract: BACKGROUND
  Protected learning time (PLT) schemes have been set up in primary care across the UK. There is little published evidence of their effectiveness.
  
  
  OBJECTIVE
  To investigate the effect of a PLT intervention for general practice to increase prescribing of ramipril for prevention of cardiovascular outcomes.
  
  
  METHODS
  Quasi-experimental, interrupted time series.
  
  
  METHODS
  Lincolnshire, UK.
  
  
  METHODS
  Prescribing data were analysed one year before and after the education for change in rate of increase of prescribing of ramipril, whether change in prescribing was related to postulated explanatory variables and to determine intervention costs.
  
  
  RESULTS
  The primary outcome was the rate of change of ramipril (10 mg) prescription items 12 months after compared with before the educational intervention. Secondary outcomes included cost.
  
  
  RESULTS
  Ramipril prescribing at therapeutic dosage increased significantly (odds ratio 1.50, 95% CI 1.07-1.93) following education by 52,345 items (31,132 items at 10 mg) at a cost of pound 292k to pound 460k depending on formulation. This occurred despite a background of secular change. Most practices were represented by GPs, nurses or both during the education. Single-handed GPs were less likely to attend. Practices showed considerable variation in response to the educational intervention. The only predictor of whether practices increased in prescribing rate after the education was whether a practice nurse had undertaken specific diabetes training. Total list size, dispensing, training or single-handed status and GP attendance did not predict a change in prescribing.
  
  
  CONCLUSIONS
  PLT schemes can contribute to beneficial changes in prescribing across a large geographical area.
authors.affiliation: School of Health and Social Care, University of Lincoln, Lincoln, UK. nsiriwardena@lincoln.ac.uk
authors.forename: A N
authors.initials: AN
authors.lastname: Siriwardena
authors.forename: P
authors.initials: P
authors.lastname: Fairchild
authors.forename: S
authors.initials: S
authors.lastname: Gibson
authors.forename: T
authors.initials: T
authors.lastname: Sach
authors.forename: M
authors.initials: M
authors.lastname: Dewey
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D048909:Diabetes Complications / Q000517:prevention & control*; D004363:Drug Utilization / Q000639:trends*; D004502:Education, Medical, Continuing; D004739:England; D005194:Family Practice / Q000193:education* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007858:Learning; D008485:Medical Audit; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D015397:Program Evaluation; D017257:Ramipril / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D013192:Staff Development; D013995:Time
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D017257:Ramipril