Effectiveness of educational outreach visits compared with usual guideline dissemination to improve family physician prescribing-an 18-month open cluster-randomized trial
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.1186/s13012-018-0810-1 |
Resumo: | Background: Educational outreach visits are meant to improve the practice of health professionals by promoting face-to-face visits to deliver educational contents. They have been shown to change prescription behavior, but long-term effects are still uncertain. This trial aimed to determine if they improve family physician prescribing compared with passive guideline dissemination. Methods: Parallel, open, superiority, and cluster-randomized trial. National Health Service primary care practices (clusters) were recruited in the Lisbon region-Portugal between March 2013 and January 2014. They could enter if they had at least four family physicians willing to participate and not planning to retire in the follow-up period. Three national guidelines were chosen for dissemination: acid secretion modifiers, non-steroidal anti-inflammatory drugs, and antiplatelets. Physicians in the intervention group received one 15 to 20min educational outreach visit at their workplace for each guideline. Physicians in the control group had access to guidelines through the Directorate-General for Health's website (passive dissemination). Primary outcomes were the proportion of COX-2 inhibitors prescribed within the NSAID class and the proportion of omeprazole within the PPI class at 18months after the intervention. A cost-benefit analysis was performed. Practices were randomized by minimization. Data analyses were done at individual physician level using generalized mixed-effects regression models. Participants could not be blinded. Results: Thirty-eight practices with 239 physicians were randomized (120 to intervention and 119 to control). Of 360 planned visits, 322 were delivered. No differences were found between physicians in the intervention and control groups regarding the proportion of omeprazole prescribed among PPIs 18months after the visit (46.28 vs 47.15%, p=0.971) or the proportion of COX-2 inhibitors among NSAIDs (12.07 vs 13.08%, p=0.085). All secondary outcome comparisons showed no effect. There was no difference in cumulative drug costs at 18months (3223.50€/1000 patients in the intervention group and 3143.92€/1000 patients in the control group, p=0.848). Conclusions: Educational outreach visits were unsuccessful in improving compliance with guideline recommendations among Portuguese family physicians. No effects were observed at 1, 6, and 18months after the intervention, and there were no associated cost savings. |
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Effectiveness of educational outreach visits compared with usual guideline dissemination to improve family physician prescribing-an 18-month open cluster-randomized trialAcademic detailingCost-benefit analysisDrug utilizationEducational outreachFamily practiceGuideline adherenceProgram evaluationHealth PolicyHealth InformaticsPublic Health, Environmental and Occupational HealthSDG 3 - Good Health and Well-beingBackground: Educational outreach visits are meant to improve the practice of health professionals by promoting face-to-face visits to deliver educational contents. They have been shown to change prescription behavior, but long-term effects are still uncertain. This trial aimed to determine if they improve family physician prescribing compared with passive guideline dissemination. Methods: Parallel, open, superiority, and cluster-randomized trial. National Health Service primary care practices (clusters) were recruited in the Lisbon region-Portugal between March 2013 and January 2014. They could enter if they had at least four family physicians willing to participate and not planning to retire in the follow-up period. Three national guidelines were chosen for dissemination: acid secretion modifiers, non-steroidal anti-inflammatory drugs, and antiplatelets. Physicians in the intervention group received one 15 to 20min educational outreach visit at their workplace for each guideline. Physicians in the control group had access to guidelines through the Directorate-General for Health's website (passive dissemination). Primary outcomes were the proportion of COX-2 inhibitors prescribed within the NSAID class and the proportion of omeprazole within the PPI class at 18months after the intervention. A cost-benefit analysis was performed. Practices were randomized by minimization. Data analyses were done at individual physician level using generalized mixed-effects regression models. Participants could not be blinded. Results: Thirty-eight practices with 239 physicians were randomized (120 to intervention and 119 to control). Of 360 planned visits, 322 were delivered. No differences were found between physicians in the intervention and control groups regarding the proportion of omeprazole prescribed among PPIs 18months after the visit (46.28 vs 47.15%, p=0.971) or the proportion of COX-2 inhibitors among NSAIDs (12.07 vs 13.08%, p=0.085). All secondary outcome comparisons showed no effect. There was no difference in cumulative drug costs at 18months (3223.50€/1000 patients in the intervention group and 3143.92€/1000 patients in the control group, p=0.848). Conclusions: Educational outreach visits were unsuccessful in improving compliance with guideline recommendations among Portuguese family physicians. No effects were observed at 1, 6, and 18months after the intervention, and there were no associated cost savings.NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)Centro de Estudos de Doenças Crónicas (CEDOC)RUNPinto, DanielHeleno, BrunoRodrigues, David S.Papoila, Ana LuísaSantos, IsabelCaetano, Pedro A.2018-10-11T22:13:14Z2018-09-052018-09-05T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.1186/s13012-018-0810-1eng1748-5908PURE: 5992809http://www.scopus.com/inward/record.url?scp=85052920428&partnerID=8YFLogxKhttps://doi.org/10.1186/s13012-018-0810-1info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-03-11T04:24:59Zoai:run.unl.pt:10362/48709Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:32:10.165366Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Effectiveness of educational outreach visits compared with usual guideline dissemination to improve family physician prescribing-an 18-month open cluster-randomized trial |
title |
Effectiveness of educational outreach visits compared with usual guideline dissemination to improve family physician prescribing-an 18-month open cluster-randomized trial |
spellingShingle |
Effectiveness of educational outreach visits compared with usual guideline dissemination to improve family physician prescribing-an 18-month open cluster-randomized trial Pinto, Daniel Academic detailing Cost-benefit analysis Drug utilization Educational outreach Family practice Guideline adherence Program evaluation Health Policy Health Informatics Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being |
title_short |
Effectiveness of educational outreach visits compared with usual guideline dissemination to improve family physician prescribing-an 18-month open cluster-randomized trial |
title_full |
Effectiveness of educational outreach visits compared with usual guideline dissemination to improve family physician prescribing-an 18-month open cluster-randomized trial |
title_fullStr |
Effectiveness of educational outreach visits compared with usual guideline dissemination to improve family physician prescribing-an 18-month open cluster-randomized trial |
title_full_unstemmed |
Effectiveness of educational outreach visits compared with usual guideline dissemination to improve family physician prescribing-an 18-month open cluster-randomized trial |
title_sort |
Effectiveness of educational outreach visits compared with usual guideline dissemination to improve family physician prescribing-an 18-month open cluster-randomized trial |
author |
Pinto, Daniel |
author_facet |
Pinto, Daniel Heleno, Bruno Rodrigues, David S. Papoila, Ana Luísa Santos, Isabel Caetano, Pedro A. |
author_role |
author |
author2 |
Heleno, Bruno Rodrigues, David S. Papoila, Ana Luísa Santos, Isabel Caetano, Pedro A. |
author2_role |
author author author author author |
dc.contributor.none.fl_str_mv |
NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM) Centro de Estudos de Doenças Crónicas (CEDOC) RUN |
dc.contributor.author.fl_str_mv |
Pinto, Daniel Heleno, Bruno Rodrigues, David S. Papoila, Ana Luísa Santos, Isabel Caetano, Pedro A. |
dc.subject.por.fl_str_mv |
Academic detailing Cost-benefit analysis Drug utilization Educational outreach Family practice Guideline adherence Program evaluation Health Policy Health Informatics Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being |
topic |
Academic detailing Cost-benefit analysis Drug utilization Educational outreach Family practice Guideline adherence Program evaluation Health Policy Health Informatics Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being |
description |
Background: Educational outreach visits are meant to improve the practice of health professionals by promoting face-to-face visits to deliver educational contents. They have been shown to change prescription behavior, but long-term effects are still uncertain. This trial aimed to determine if they improve family physician prescribing compared with passive guideline dissemination. Methods: Parallel, open, superiority, and cluster-randomized trial. National Health Service primary care practices (clusters) were recruited in the Lisbon region-Portugal between March 2013 and January 2014. They could enter if they had at least four family physicians willing to participate and not planning to retire in the follow-up period. Three national guidelines were chosen for dissemination: acid secretion modifiers, non-steroidal anti-inflammatory drugs, and antiplatelets. Physicians in the intervention group received one 15 to 20min educational outreach visit at their workplace for each guideline. Physicians in the control group had access to guidelines through the Directorate-General for Health's website (passive dissemination). Primary outcomes were the proportion of COX-2 inhibitors prescribed within the NSAID class and the proportion of omeprazole within the PPI class at 18months after the intervention. A cost-benefit analysis was performed. Practices were randomized by minimization. Data analyses were done at individual physician level using generalized mixed-effects regression models. Participants could not be blinded. Results: Thirty-eight practices with 239 physicians were randomized (120 to intervention and 119 to control). Of 360 planned visits, 322 were delivered. No differences were found between physicians in the intervention and control groups regarding the proportion of omeprazole prescribed among PPIs 18months after the visit (46.28 vs 47.15%, p=0.971) or the proportion of COX-2 inhibitors among NSAIDs (12.07 vs 13.08%, p=0.085). All secondary outcome comparisons showed no effect. There was no difference in cumulative drug costs at 18months (3223.50€/1000 patients in the intervention group and 3143.92€/1000 patients in the control group, p=0.848). Conclusions: Educational outreach visits were unsuccessful in improving compliance with guideline recommendations among Portuguese family physicians. No effects were observed at 1, 6, and 18months after the intervention, and there were no associated cost savings. |
publishDate |
2018 |
dc.date.none.fl_str_mv |
2018-10-11T22:13:14Z 2018-09-05 2018-09-05T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.1186/s13012-018-0810-1 |
url |
https://doi.org/10.1186/s13012-018-0810-1 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
1748-5908 PURE: 5992809 http://www.scopus.com/inward/record.url?scp=85052920428&partnerID=8YFLogxK https://doi.org/10.1186/s13012-018-0810-1 |
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info:eu-repo/semantics/openAccess |
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openAccess |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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1799137944291770368 |