Effectiveness of educational outreach visits compared with usual guideline dissemination to improve family physician prescribing-an 18-month open cluster-randomized trial

Daniel Pinto, Bruno Heleno, David S Rodrigues, Ana Luísa Papoila, Isabel Santos, Pedro A Caetano, Daniel Pinto, Bruno Heleno, David S Rodrigues, Ana Luísa Papoila, Isabel Santos, Pedro A Caetano

Abstract

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 20 min 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 18 months 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 18 months 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 18 months (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 18 months after the intervention, and there were no associated cost savings.

Trial registration: ClinicalTrials.gov NCT01984034 . Registered 7 November 2013.

Keywords: Academic detailing; Cost-benefit analysis; Drug utilization; Educational outreach; Family practice; Guideline adherence; Program evaluation.

Conflict of interest statement

Authors’ information

DP: MD, PhD-candidate; Family Medicine Unit, Grupo de Investigação Académica Independente - Chronic Diseases Research Center, NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal.

BH: MD, PhD; Family Medicine Unit, Grupo de Investigação Académica Independente - Chronic Diseases Research Center, NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal.

DSR: MD, PhD-candidate; Family Medicine Unit, Grupo de Investigação Académica Independente - Chronic Diseases Research Center, NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal.

ALP: BMath, MStat, PhD; Department of Biostatistics, Chronic Diseases Research Center; NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal, Center of Statistics and Applications, Universidade de Lisboa.

IS: MD, MEd, PhD; Family Medicine Unit, Grupo de Investigação Académica Independente - Chronic Diseases Research Center, NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal.

PAC: PharmD, PhD, MPH; former member of Grupo de Investigação Académica Independente - Chronic Diseases Research Center, NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal.

Ethics approval and consent to participate

The trial was approved by the ethics committees of the Lisbon Regional Health Administration and NOVA Medical School. Family physicians gave consent to participate. The trial only collected aggregated and non-identifiable patient data.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Participant flow diagram
Fig. 2
Fig. 2
Prescription timeline of drugs in primary and secondary outcomes (vertical bars) from 1 month before the intervention (− 1) to 18 months after the intervention (18) in the intervention (black line) and control (gray line) groups

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