Group versus individual academic detailing to improve the use of antihypertensive medications in primary care: a cluster-randomized controlled trial
Received 27 August 2004; accepted 19 December 2004.
Purpose
To compare group versus individual academic detailing to increase diuretic or β-blocker use in hypertension.
Methods
We conducted a cluster-randomized controlled trial in a large health maintenance organization. Subjects (N=9820) were patients with newly treated hypertension in the year preceding the intervention (N=3692), the 9 months following the intervention (N=3556), and the second year following intervention (N=2572). We randomly allocated 3 practice sites to group detailing (N=227 prescribers), 3 to individual detailing (N=235 prescribers), and 3 to usual care (N=319 prescribers). Individual detailing entailed a physician-educator meeting individually with clinicians to address barriers to prescribing guideline-recommended medications. The group detailing intervention incorporated the same social marketing principles in small groups of clinicians.
Results
In the first year following the intervention, the rates of diuretic or β-blocker use increased by 13.2% in the group detailing practices, 12.5% in the individual detailing practices, and 6.2% in the usual care practices. As compared with usual care practices, diuretic or β-blocker use was more likely in group detailing practices (adjusted odds ratio (OR), 1.40; 95% confidence interval (CI), 1.11 – 1.76) and individual detailing practices (adjusted OR, 1.30; 95% CI, 0.95 – 1.79). Neither intervention affected blood pressure control. Two years following this single-visit intervention, there was still a trend suggesting a persistent effect of individual (OR, 1.22; 95% CI, 0.92 – 1.62), but not group, detailing (OR, 1.06; 95% CI, 0.80 – 1.39), as compared with usual care.
Conclusion
Both group and individual academic detailing improved antihypertensive prescribing over and above usual care but may require reinforcement to sustain improvements.
dHarvard Vanguard Medical Associates, Medford, Massachusetts.
Requests for reprints should be addressed to Steven R. Simon, MD, MPH, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, Sixth Floor, Boston, MA 02215.
Funding/Support: This work was supported by a cooperative agreement (U18 HS 12019) from the Agency for Healthcare Research and Quality. Dr. Majumdar is a Population Health Investigator of the Alberta Heritage Foundation for Medical Research and a New Investigator of the Canadian Institutes of Health Research. Drs. Simon and Soumerai are investigators in the HMO Research Network Center for Education and Research in Therapeutics funded by the Agency for Healthcare Research and Quality (U18HS010391).
Role of the Sponsor: The funders had no role in the design of the study, analysis of the data, interpretation of the results, or the decision to publish.
ABSTRACT
