Long Term Effectiveness on Prescribing of Two Multifaceted Educational Interventions: Results of Two Large Scale Randomized Cluster TrialsReport as inadecuate




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Introduction

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.

Objectives

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.

Interpretation

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.

Trial Registration

Controlled-Trials.com ISRCTN05866587



Author: Nicola Magrini , Giulio Formoso, Oreste Capelli, Emilio Maestri, Francesco Nonino, Barbara Paltrinieri, Cinzia Del Giovane, Claud

Source: http://plos.srce.hr/



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