Impact of short evidence summaries in discharge letters on adherence of practitioners to discharge medication. A cluster-randomised controlled trial.
BACKGROUND
International concern about quality of medical care has led to intensive study of interventions to ensure care is consistent with best evidence. Simple, inexpensive, feasible and effective interventions remain limited.


OBJECTIVE
We examined the impact of one-sentence evidence summaries appended to consultants' letters to primary care practitioners on adherence of the practitioners to recommendations made by the consultants regarding medication for patients with chronic medical problems.


METHODS
Cluster-randomised trial.


METHODS
Secondary/primary care interface (urban district hospital/referral practices).


METHODS
178 practices received one or more discharge letters with evidence summaries. The 66 practices in the intervention group provided feedback on 172 letters, and the 56 practices in the control group provided feedback on 96 letters.


RESULTS
Appending an evidence summary to discharge letters resulted in a decrease in non-adherence to discharge medication from 29.6% to 18.5% (difference adjusted for underlying medical condition 12.5%; p = 0.039). Among the five possible reasons for discontinuing discharge medication, the evidence summaries seemed to have the largest impact on budget-related reasons for discontinuation (2.6% in the intervention versus 10.7% in the control group (p = 0.052)). Most clinicians (72%) were enthusiastic about continuing receiving evidence summaries with discharge letters in routine care.


CONCLUSIONS
The one-sentence evidence summary is a simple, inexpensive, well-accepted intervention that may improve primary care practitioners' adherence to evidence-based consultant recommendations.
Basel Institute for Clinical Epidemiology, University Hospital Basel, Hebelstrasse 10, CH-4031 Basel, Switzerland. rkunz@uhbs.ch
R
R
Kunz
K
K
Wegscheider
G
G
Guyatt
W
W
Zielinski
N
N
Rakowsky
N
N
Donner-Banzhoff
S
S
Müller-Lissner
D001604:Berlin; D002391:Catchment Area, Health; D002908:Chronic Disease / Q000188:drug therapy*; D016000:Cluster Analysis; D003266:Continuity of Patient Care / Q000458:organization & administration*; D015709:Correspondence as Topic; D005194:Family Practice / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006748:Hospital Departments / Q000458:organization & administration*; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D033183:Interdisciplinary Communication; D007388:Internal Medicine / Q000458:organization & administration*; D010351:Patient Discharge / Q000592:standards*; D012017:Referral and Consultation / Q000458:organization & administration*