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Feedback of prescribing to general practitioners increased the appropriate use of aspirin
Evidence-based clinical practice
© HarcourtBraceandCompanyLtd 1998
Feedback of prescribing to general practitioners increased the appropriate use of aspirin
to the proportion on aspirin after the intervention (a period of at least 3 months). This data was collected from practice computers, but to ensure validity, a random sample was checked for accuracy by comp,'u-isonwith the written records. Results
McCartney P, Macdowell W, Thorogood M. A randomised trial of feedback to general practitioners of their prophylactic aspirin prescribing. BMJ 1997; 315:35-36
Background
Literature review
There is a need to identify methods that can change professional practice to ensure faster uptake of research findings.
No explicit strategy; four references.
Objective To assess the effectiveness of feedback to general practitioners (GPs) aimed at increasing the use of aspirin in patients with heart disease. Selling
Intervenlion The practices randomized to the intervention group received feedback on their baseline prescribing of aspirin, together with education on the known benefits of the use of aspirin in patients with heart disease. This session was the only intervention during the trial. The control group of practices received feedback and education on hormone replacement therapy.
General practices in London, UK. Outcomes
Method Randomized, controlled trial.
:OMMENTAR~ Any intervention that can reduce mortality by 1134 deaths over a period of 2 years is worth a second look. The monitoring and prevention of cardiovascular disease is a major problem for primary care. In this group of patients, the use of simple and cheap medication has been shown to be highly effective. The AntiPlatelet Trialists Collaboration showed the benefits of using aspirin in various groups of patients with cardiovascular disease) After this important review was published in 1994, several guidelineswere issued. Without other interventions, the publication of guidelines led to the varied use of aspirin shown by McCartney et al. Since then, the use of aspirin by patients with proven cardiovascular disease has been widely disseminated in peer-reviewed journals, medical newspapers and the general press. However, the low usage of aspirin is still a major cause for concern. I was surprised at the variation between practices in the numbers of patients who had
52
The proportion of patients with heart disease on aspirin before the intervention compared
cardiovascular disease and were using aspirin. However, the simple 1-hour session clearly has a major impact in changing practice behavior. Academic detailing has been shown to have this potential but does require the presence of a well-respected authoritative figure? Another potential problem is the lack of enthusiasm or eligibility for this trial by nearly half of those approached. This may reduce the impact of this strategy when introduced in different areas. I was surprised to see that only 5% of patients bought aspirin themselves. For practices thinking about introducing secondary prevention programs for patients with cardiovascular disease, this figure will be important when auditing the current status of aspirin usage. Despite the obvious beneficial impact of this educational strategy, it is still worrying that so many patients leave hospital and/or primary care presumably without the necessary knowledge to ensure their use of aspirin. This use of academic detailing must be regarded as only one of the many strategies for increasing the use of aspirin in
EVIDENCE-BASED HEALTH POLICY AND MANAGEMENT
In practices randomized to feedback and education on aspirin, 47.8% of patients were prescribed aspirin at baseline, and 58.2% were prescribed aspirin at the end of the study period. In control practices randomized to feedback and education on hormone replacement therapy (HRT), 48.6% of patients were prescribed aspirin at baseline, and 50% were prescribed aspirin at the end of the study period, with no statistically significant difference. Authors' conclusions The authors concluded that feedback of prescribing practice and education in a single session can increase the proportion of patients receiving prescribed aspirin by 9%. A nationwide increase in aspirin prescribing may prevent 1134 deaths every 2 years. However, although this sounds impressive, it still requires a significant input at a local level. At least six practices would need to undergo an intervention of this type to prevent one death every 2 years.
this group of patients. Policy-makers should consider patient awareness programs, discharge protocols, computerized prompts as well as education. The responsibility for ensuring maximum use of anti-platelet therapy must eventually be shared between primary and secondary care as well as the patients themselves.
References
1. Collaboration A T. Collaborative overview of randomised trials of antiplatelet therapy-l: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelettherapy in various categories of patients. BMJ 1994; 308:81-106 2. Davis D A, Thomson M A, Oxman A D, Haynes R B. Changing physician performance. A systematicreview of the effect of continuing medical education strategies (seecomments) JAMA 1995; 274(9): 700-705 Dr Martin Dawes Department of Public Health & Primary Care University of Oxford, Oxford, UK
JUNE 1998
© HarcourtBraceandCompanyLtd 1998
Feedback of prescribing to general practitioners increased the appropriate use of aspirin
to the proportion on aspirin after the intervention (a period of at least 3 months). This data was collected from practice computers, but to ensure validity, a random sample was checked for accuracy by comp,'u-isonwith the written records. Results
McCartney P, Macdowell W, Thorogood M. A randomised trial of feedback to general practitioners of their prophylactic aspirin prescribing. BMJ 1997; 315:35-36
Background
Literature review
There is a need to identify methods that can change professional practice to ensure faster uptake of research findings.
No explicit strategy; four references.
Objective To assess the effectiveness of feedback to general practitioners (GPs) aimed at increasing the use of aspirin in patients with heart disease. Selling
Intervenlion The practices randomized to the intervention group received feedback on their baseline prescribing of aspirin, together with education on the known benefits of the use of aspirin in patients with heart disease. This session was the only intervention during the trial. The control group of practices received feedback and education on hormone replacement therapy.
General practices in London, UK. Outcomes
Method Randomized, controlled trial.
:OMMENTAR~ Any intervention that can reduce mortality by 1134 deaths over a period of 2 years is worth a second look. The monitoring and prevention of cardiovascular disease is a major problem for primary care. In this group of patients, the use of simple and cheap medication has been shown to be highly effective. The AntiPlatelet Trialists Collaboration showed the benefits of using aspirin in various groups of patients with cardiovascular disease) After this important review was published in 1994, several guidelineswere issued. Without other interventions, the publication of guidelines led to the varied use of aspirin shown by McCartney et al. Since then, the use of aspirin by patients with proven cardiovascular disease has been widely disseminated in peer-reviewed journals, medical newspapers and the general press. However, the low usage of aspirin is still a major cause for concern. I was surprised at the variation between practices in the numbers of patients who had
52
The proportion of patients with heart disease on aspirin before the intervention compared
cardiovascular disease and were using aspirin. However, the simple 1-hour session clearly has a major impact in changing practice behavior. Academic detailing has been shown to have this potential but does require the presence of a well-respected authoritative figure? Another potential problem is the lack of enthusiasm or eligibility for this trial by nearly half of those approached. This may reduce the impact of this strategy when introduced in different areas. I was surprised to see that only 5% of patients bought aspirin themselves. For practices thinking about introducing secondary prevention programs for patients with cardiovascular disease, this figure will be important when auditing the current status of aspirin usage. Despite the obvious beneficial impact of this educational strategy, it is still worrying that so many patients leave hospital and/or primary care presumably without the necessary knowledge to ensure their use of aspirin. This use of academic detailing must be regarded as only one of the many strategies for increasing the use of aspirin in
EVIDENCE-BASED HEALTH POLICY AND MANAGEMENT
In practices randomized to feedback and education on aspirin, 47.8% of patients were prescribed aspirin at baseline, and 58.2% were prescribed aspirin at the end of the study period. In control practices randomized to feedback and education on hormone replacement therapy (HRT), 48.6% of patients were prescribed aspirin at baseline, and 50% were prescribed aspirin at the end of the study period, with no statistically significant difference. Authors' conclusions The authors concluded that feedback of prescribing practice and education in a single session can increase the proportion of patients receiving prescribed aspirin by 9%. A nationwide increase in aspirin prescribing may prevent 1134 deaths every 2 years. However, although this sounds impressive, it still requires a significant input at a local level. At least six practices would need to undergo an intervention of this type to prevent one death every 2 years.
this group of patients. Policy-makers should consider patient awareness programs, discharge protocols, computerized prompts as well as education. The responsibility for ensuring maximum use of anti-platelet therapy must eventually be shared between primary and secondary care as well as the patients themselves.
References
1. Collaboration A T. Collaborative overview of randomised trials of antiplatelet therapy-l: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelettherapy in various categories of patients. BMJ 1994; 308:81-106 2. Davis D A, Thomson M A, Oxman A D, Haynes R B. Changing physician performance. A systematicreview of the effect of continuing medical education strategies (seecomments) JAMA 1995; 274(9): 700-705 Dr Martin Dawes Department of Public Health & Primary Care University of Oxford, Oxford, UK
JUNE 1998