An open cluster-randomized, 18-month trial to compare the effectiveness of educational outreach visits with usual guideline dissemination to improve family physician prescribingReportar como inadecuado

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Implementation Science

, 9:10

First Online: 15 January 2014Received: 24 November 2013Accepted: 11 January 2014DOI: 10.1186-1748-5908-9-10

Cite this article as: Pinto, D., Heleno, B., Rodrigues, D.S. et al. Implementation Sci 2014 9: 10. doi:10.1186-1748-5908-9-10


BackgroundThe Portuguese National Health Directorate has issued clinical practice guidelines on prescription of anti-inflammatory drugs, acid suppressive therapy, and antiplatelets. However, their effectiveness in changing actual practice is unknown.

MethodsThe study will compare the effectiveness of educational outreach visits regarding the improvement of compliance with clinical guidelines in primary care against usual dissemination strategies. A cost-benefit analysis will also be conducted. We will carry out a parallel, open, superiority, randomized trial directed to primary care physicians. Physicians will be recruited and allocated at a cluster-level primary care unit by minimization. Data will be analyzed at the physician level. Primary care units will be eligible if they use electronic prescribing and have at least four physicians willing to participate. Physicians in intervention units will be offered individual educational outreach visits one for each guideline at their workplace during a six-month period. Physicians in the control group will be offered a single unrelated group training session. Primary outcomes will be the proportion of cyclooxygenase-2 inhibitors prescribed in the anti-inflammatory class, and the proportion of omeprazole in the proton pump inhibitors class at 18 months post-intervention. Prescription data will be collected from the regional pharmacy claims database. We estimated a sample size of 110 physicians in each group, corresponding to 19 clusters with a mean size of 6 physicians. Outcome collection and data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and detailers cannot be blinded.

DiscussionThis trial will attempt to address unresolved issues in the literature, namely, long term persistence of effect, the importance of sequential visits in an outreach program, and cost issues. If successful, this trial may be the cornerstone for deploying large scale educational outreach programs within the Portuguese National Health Service.

Trial number NCT01984034.

KeywordsEducational outreach Academic detailing Guideline adherence Family practice Drug utilization Program evaluation Cost-benefit analysis AbbreviationsATCAnatomical therapeutic chemical classification


ICCIntra-cluster correlation coefficient

NHSNational Health Service Portugal

NSAIDsNon-steroidal anti-inflammatory drugs

PPIsProton pump inhibitors

SDStandard deviation.

Electronic supplementary materialThe online version of this article doi:10.1186-1748-5908-9-10 contains supplementary material, which is available to authorized users.

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Autor: Daniel Pinto - Bruno Heleno - David S Rodrigues - Ana Luísa Papoila - Isabel Santos - Pedro A Caetano


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