BACKGROUND: There is increasing evidence that clinical guidelines can lead to improvements in clinical care. However, they are not self-implementing. Outreach visits may improve prescribing behaviour. METHODS: Within a before-and-after pragmatic randomized controlled trial, involving all general practices in one health district, routine methods were used to distribute guidelines for management of Helicobacter pylori eradication. Intervention practices were offered a visit and the conduct of an audit by a pharmacist trained in the techniques of outreach visiting. The intervention was evaluated using level three Prescribing Analysis and Cost (PACT) data for metronidazole and omeprazole for the two 12 month periods around the introduction of the guidelines. RESULTS: Of the 38 intervention practices 19 accepted an outreach visit and three accepted the offer of an audit. There was a significant increase in omeprazole use during the study of 0.24 [95 per cent confidence interval (CI) +0.19 to +0.29] dose units per year but no effect from the offer [-0.02 (95 per cent CI -0.12 to +0.08) dose units] or acceptance of a visit [-0.03 (95 per cent CI -0.15 to +0.08) dose units]. The results for metronidazole were similar, with an increase in use of 0.028 (95 per cent CI +0.018 to +0.038) dose units per year. The effect of the intervention was a non-significant change in prescribing of -0.005 (95 per cent CI -0.025 to +0.015) dose units. Accepting a visit had little effect on prescribing: a change of 0.003 (95 per cent CI -0.021 to +0.027) dose units. CONCLUSIONS: The routine use of untargeted outreach visiting is probably not a worthwhile strategy.
RCT Entities:
BACKGROUND: There is increasing evidence that clinical guidelines can lead to improvements in clinical care. However, they are not self-implementing. Outreach visits may improve prescribing behaviour. METHODS: Within a before-and-after pragmatic randomized controlled trial, involving all general practices in one health district, routine methods were used to distribute guidelines for management of Helicobacter pylori eradication. Intervention practices were offered a visit and the conduct of an audit by a pharmacist trained in the techniques of outreach visiting. The intervention was evaluated using level three Prescribing Analysis and Cost (PACT) data for metronidazole and omeprazole for the two 12 month periods around the introduction of the guidelines. RESULTS: Of the 38 intervention practices 19 accepted an outreach visit and three accepted the offer of an audit. There was a significant increase in omeprazole use during the study of 0.24 [95 per cent confidence interval (CI) +0.19 to +0.29] dose units per year but no effect from the offer [-0.02 (95 per cent CI -0.12 to +0.08) dose units] or acceptance of a visit [-0.03 (95 per cent CI -0.15 to +0.08) dose units]. The results for metronidazole were similar, with an increase in use of 0.028 (95 per cent CI +0.018 to +0.038) dose units per year. The effect of the intervention was a non-significant change in prescribing of -0.005 (95 per cent CI -0.025 to +0.015) dose units. Accepting a visit had little effect on prescribing: a change of 0.003 (95 per cent CI -0.021 to +0.027) dose units. CONCLUSIONS: The routine use of untargeted outreach visiting is probably not a worthwhile strategy.
Authors: C Hendricks Brown; Geoffrey Curran; Lawrence A Palinkas; Gregory A Aarons; Kenneth B Wells; Loretta Jones; Linda M Collins; Naihua Duan; Brian S Mittman; Andrea Wallace; Rachel G Tabak; Lori Ducharme; David A Chambers; Gila Neta; Tisha Wiley; John Landsverk; Ken Cheung; Gracelyn Cruden Journal: Annu Rev Public Health Date: 2017-03-20 Impact factor: 21.981
Authors: M A O'Brien; S Rogers; G Jamtvedt; A D Oxman; J Odgaard-Jensen; D T Kristoffersen; L Forsetlund; D Bainbridge; N Freemantle; D A Davis; R B Haynes; E L Harvey Journal: Cochrane Database Syst Rev Date: 2007-10-17
Authors: Paola Dey; Carl W R Simpson; Stuart I Collins; G Hodgson; Christopher F Dowrick; A J M Simison; M J Rose Journal: Br J Gen Pract Date: 2004-01 Impact factor: 5.386
Authors: Martin P Eccles; Gillian Hawthorne; Marie Johnston; Margaret Hunter; Nick Steen; Jill Francis; Susan Hrisos; Marko Elovainio; Jeremy M Grimshaw Journal: Implement Sci Date: 2009-04-27 Impact factor: 7.327
Authors: Anne E Walker; Jeremy Grimshaw; Marie Johnston; Nigel Pitts; Nick Steen; Martin Eccles Journal: BMC Health Serv Res Date: 2003-12-19 Impact factor: 2.655