A clustered randomized trial of the effects of feedback using academic detailing compared to postal bulletin on prescribing of preventative cardiovascular therapy.
BACKGROUND
Interventions to promote prescribing of preventive therapies in patients with cardiovascular disease (CVD) or diabetes have reported variable success.


OBJECTIVE
(i) To evaluate the effect of prescribing feedback on GP practice using academic detailing compared to postal bulletin on prescribing of CVD preventive therapies in patients with CVD or diabetes at 3 and 6 months post intervention and (ii) to evaluate the intervention from a GP's perspective.


METHODS
Volunteer GP practices (n = 98) were randomized to receive individualized prescribing feedback via academic detailing (postal bulletin plus outreach visit) (n = 48) or postal bulletin (n = 50). The proportion of CVD or diabetic patients on statins and antiplatelet agents/warfarin pre- and post-intervention was calculated for each GP practice. Multivariate regression with a random effects model was used to compare differences between the groups adjusting for GP clustering and confounding factors. beta-Coefficients and 95% confidence intervals (CIs) are presented.


RESULTS
There was a 3% increase in statin prescribing in CVD patients at 6 months post-intervention for both randomized groups, but there was no statistical difference between the groups (beta = 0.004; 95% CI = -0.01 to 0.02). Statin and antiplatelet/warfarin prescribing also increased in the diabetic population; there was no significant differences between the groups. GPs participating in the project expressed a high level of satisfaction with both interventions.


CONCLUSIONS
Prescribing of preventive therapies increased in both randomized groups over the study period. But academic detailing did not have an additional effect on changing prescribing over the postal bulletin alone.
Department of Pharmacology and Therapeutics, Trinity College, Trinity Centres for Health Sciences St James Hospital, Dublin D 8, Ireland. naughtc@tcd.ie
Corina
C
Naughton
John
J
Feely
Kathleen
K
Bennett
D000925:Anticoagulants / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D016000:Cluster Analysis; D048909:Diabetes Complications / Q000517:prevention & control*; D017723:Drug Utilization Review; D004502:Education, Medical, Continuing / Q000379:methods*; D030141:Feedback, Psychological; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D010821:Physicians, Family / Q000193:education* / Q000523:psychology / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011177:Postal Service; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015397:Program Evaluation; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin