title: Effects of 2 educational interventions on the management of hypertensive patients in primary health care.
abstract: BACKGROUND
  Experimental studies on the effectiveness of educational interventions to improve patient care are scarce, especially for low-resources settings. This study investigated the effects of 2 educational interventions on the treatment of hypertensive patients in primary health care in Brazil.
  
  
  METHODS
  Forty-one physicians were randomly assigned either to an "active educational intervention" (21 physicians) or to a "passive educational intervention" (20 physicians). The former comprised 1 small group discussion of routine practices, 1 outreach visit, and 3 reminders. The latter consisted of delivery of printed guidelines. Measures of quality of treatment provided for hypertensive patients (181 patients of physicians from the active intervention; 136 patients of physicians from the passive intervention) were obtained through patient interview and charts review, before and 3 months after the intervention. Chi-square and independent t-tests were performed for comparison between the conditions.
  
  
  RESULTS
  The groups did not differ before the study. After the intervention, the active intervention group outperformed the passive intervention group in several measures, such as improved prescription of antihypertensive drugs (80% of patients of physicians from the active intervention vs 51% patients of physicians from the passive intervention; p < .01), prescription of aspirin (18% vs 6%; p < .01) and hypolipidemic drugs for high-risk patients (39% vs 21%; p < .01), dietary counseling (76% vs 61%; p < .01), guidance on cardiovascular risk (20% vs 3%; p < .01). Patient outcomes did not differ.
  
  
  CONCLUSIONS
  A multifaceted intervention based on review of practices improved treatment of hypertensive patients in a low-resource setting whereas delivery of guidelines did not help. None of the interventions affected patient outcomes.
authors.forename: Henderson Barbosa
authors.initials: HB
authors.lastname: Pimenta
authors.forename: Antonio Prates
authors.initials: AP
authors.lastname: Caldeira
authors.forename: Sílvia
authors.initials: S
authors.lastname: Mamede
mesh_terms: D000328:Adult; D001938:Brazil; D019468:Disease Management; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D018024:Peer Review, Health Care / Q000379:methods; D058007:Physicians, Primary Care / Q000193:education*; D011204:Poverty Areas; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D015397:Program Evaluation; D019984:Quality Indicators, Health Care
keywords: continuing medical education; evaluation-educational intervention; hypertension; reflective practice; small group/team learning