Abstract
BackgroundIn Belgium, the debate about the effect of the national academic detailing service (ADS) on prescribing quality in general practice is ongoing. In order to evaluate both the implementation strategies of the ADS and its effectiveness on appropriate prescribing of pain relief medication, we conducted a real-world cluster randomized controlled trial (cRCT).MethodsIn a pragmatic cRCT, all Belgian general practices previously visited by Farmaka were assessed for eligibility and randomized. Only practices randomized to the intervention group were invited for an academic detailing visit on appropriate prescribing of pain relief medication. GPs were unaware of the study, ensuring the production of real-world evidence but were given the option to opt out from the analysis. An objective outcome assessment was obtained using routinely collected reimbursement data. Primary outcomes were the proportion of patients reimbursed for an analgesic or NSAID, the defined daily dose of paracetamol per patient per month, the proportion of patients reimbursed for a recommended NSAID among those reimbursed for any NSAID and the proportion of patients reimbursed for both an NSAID and a proton pump inhibitor among those reimbursed for an NSAID. The impact of practice, GP and academic detailer characteristics were also assessed.ResultsThree thousand five hundred twenty-nine general practices (4530 GPs) were eligible and randomized. One thousand six hundred ninety-eight practices (2171 GPs) in the intervention group and one thousand seven hundred three (2163 GPs) in the control group were included in the analysis. The intervention had a significant impact on the proportion of patients reimbursed for a recommended NSAID among those reimbursed for any NSAID (increase in odds (95% CI): 19% (10–29%)). A clear impact on other outcomes could not be detected. Additionally, we showed that the characteristics of the academic detailers might impact the effectiveness of the visit.ConclusionsNational implementation of academic detailing in Belgian general practices provided by Farmaka significantly improved the proportion of recommended NSAIDs prescribed by GPs, but not other outcomes related to appropriate prescribing of pain relief medication.Trial registrationNCT01761864. Registered 2 January 2013.
Highlights
In Belgium, the debate about the effect of the national academic detailing service (ADS) on prescribing quality in general practice is ongoing
National implementation of academic detailing in Belgian general practices provided by Farmaka significantly improved the proportion of recommended nonsteroidal anti-inflammatory drug (NSAID) prescribed by General practitioner (GP), but not other outcomes related to appropriate prescribing of pain relief medication
In line with the planning of the ADS and the recommendations by Borgermans et al, we focused on the visits in 2013 on appropriate use of pain relief medication for chronic pain in osteoarthritis which is a common condition in which the GP plays an important role and for which a great impact could be expected given the room for improvement in osteoarthritis care
Summary
In Belgium, the debate about the effect of the national academic detailing service (ADS) on prescribing quality in general practice is ongoing. In order to evaluate both the implementation strategies of the ADS and its effectiveness on appropriate prescribing of pain relief medication, we conducted a real-world cluster randomized controlled trial (cRCT). Several continuing medical education (CME) initiatives aim to support general practitioners (GPs) to cope with the ever increasing amount of novel professional information. Most CME strategies (e.g. conferences) have mixed effects, but academic detailing (AD) is especially effective for improving the quality of prescribing in general practice [2]. A Cochrane review of randomized controlled trials (RCTs) showed that AD improved quality of care, with the effect on prescribing quality being small (3–6.5%) but larger than that of other strategies [4]. AD has been shown to be feasible with a majority of GPs who wished to receive future visits [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
