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.
Key words
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Article info
Publication history
Accepted:
December 19,
2004
Received:
August 27,
2004
Footnotes
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.
Identification
Copyright
© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
