title: Long term effectiveness on prescribing of two multifaceted educational interventions: results of two large scale randomized cluster trials.
abstract: BACKGROUND
  Information on benefits and risks of drugs is a key element affecting doctors' prescribing decisions. Outreach visits promoting independent information have proved moderately effective in changing prescribing behaviours.
  
  
  OBJECTIVE
  Testing the short and long-term effectiveness on general practitioners' prescribing of small groups meetings led by pharmacists.
  
  
  METHODS
  Two cluster open randomised controlled trials (RCTs) were carried out in a large scale NHS setting. Ad hoc prepared evidence based material were used considering a therapeutic area approach--TEA, with information materials on osteoporosis or prostatic hyperplasia--and a single drug oriented approach--SIDRO, with information materials on me-too drugs of 2 different classes: barnidipine or prulifloxacin. In each study, all 115 Primary Care Groups in a Northern Italy area (2.2 million inhabitants, 1737 general practitioners) were randomised to educational small groups meetings, in which available evidence was provided together with drug utilization data and clinical scenarios. Main outcomes were changes in the six-months prescription of targeted drugs. Longer term results (24 and 48 months) were also evaluated.
  
  
  RESULTS
  In the TEA trial, one of the four primary outcomes showed a reduction (prescription of alfuzosin compared to tamsulosin and terazosin in benign prostatic hyperplasia: prescribing ratio -8.5%, p = 0.03). Another primary outcome (prescription of risedronate) showed a reduction at 24 and 48 months (-7.6%, p = 0.02; and -9,8%, p = 0.03), but not at six months (-5.1%, p = 0.36). In the SIDRO trial both primary outcomes showed a statistically significant reduction (prescription of barnidipine -9.8%, p = 0.02; prescription of prulifloxacin -11.1%, p = 0.04), which persisted or increased over time.
  
  
  CONCLUSIONS
  These two cluster RCTs showed the large scale feasibility of a complex educational program in a NHS setting, and its potentially relevant long-term impact on prescribing habits, in particular when focusing on a single drug. National Health systems should invest in independent drug information programs.
  
  
  BACKGROUND
  Controlled-Trials.com ISRCTN05866587.
authors.affiliation: Drug Evaluation Area, Emilia-Romagna Regional Agency for Health and Social Care, Bologna, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Magrini
authors.affiliation: Drug Evaluation Area, Emilia-Romagna Regional Agency for Health and Social Care, Bologna, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Formoso
authors.affiliation: Local Health Authority, Modena, Italy.
authors.forename: Oreste
authors.initials: O
authors.lastname: Capelli
authors.affiliation: Drug Evaluation Area, Emilia-Romagna Regional Agency for Health and Social Care, Bologna, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Maestri
authors.affiliation: Drug Evaluation Area, Emilia-Romagna Regional Agency for Health and Social Care, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nonino
authors.affiliation: Drug Evaluation Area, Emilia-Romagna Regional Agency for Health and Social Care, Bologna, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Paltrinieri
authors.affiliation: Department of Clinical and Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Del Giovane
authors.affiliation: Drug Evaluation Area, Emilia-Romagna Regional Agency for Health and Social Care, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Voci
authors.affiliation: Drug Evaluation Area, Emilia-Romagna Regional Agency for Health and Social Care, Bologna, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Magnano
authors.affiliation: Local Health Authority, Modena, Italy.
authors.forename: Lisa
authors.initials: L
authors.lastname: Daya
authors.affiliation: Drug Evaluation Area, Emilia-Romagna Regional Agency for Health and Social Care, Bologna, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Marata
mesh_terms: D003226:Congresses as Topic; D004346:Drug Information Services / Q000458:organization & administration / Q000592:standards*; D011307:Drug Prescriptions / Q000592:standards*; D017723:Drug Utilization Review; D058005:General Practitioners / Q000193:education*; D007400:Interprofessional Relations; D010595:Pharmacists; D017410:Practice Guidelines as Topic