Abstract
BackgroundEducational 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.MethodsParallel, 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.ResultsThirty-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).ConclusionsEducational 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 registrationClinicalTrials.gov NCT01984034. Registered 7 November 2013.
Highlights
Educational outreach visits are meant to improve the practice of health professionals by promoting face-to-face visits to deliver educational contents
Educational outreach visits are a type of strategy aimed at improving clinical practice [7, 8]
Participants Recruitment began in March 2013 and ended in January 2014
Summary
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. Among them are not being aware of or familiar with guidelines, considering they are ambiguous or disagreeing with recommendations, perceiving lack of self-efficacy, organizational constraints, and patient barriers [2, 3] This may contribute to the problem of translating new medical knowledge to improvements in public health and of affordability of care [4, 5]. A systematic review concluded that educational outreach visits have a small, but consistent and potentially important, effect on prescription improvement [8] It highlighted a gap in knowledge about the performance of this type of intervention in the long term (beyond 1 year). Trials using multifaceted interventions that included educational outreach to reduce inappropriate prescribing showed sustained effectiveness 1 year after the intervention [10,11,12], but it is unclear if educational outreach alone can achieve the same effect
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