BACKGROUND: Local opinion leaders are educationally and socially influential physicians. Although they can accelerate the adoption of new evidence in hospitals, their impact on the quality of prescribing for outpatients has only been examined by a few studies. We hypothesized that an intervention consisting of patient-specific one-page evidence summaries, generated and endorsed by local opinion leaders, would improve prescribing of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in heart failure (HF) and that of statins in ischemic heart disease (IHD). METHODS: We conducted a community-based randomized controlled trial in patients with HF (not receiving ACE inhibitors or ARBs) and those with IHD (not receiving statins) who were recruited from 40 pharmacies and allocated either to theopinion leader intervention or to usual care based on randomization of their primary care physician. The primary outcome was an increase in the use of efficacious therapies (ACE inhibitors or ARBs in HF and statins in IHD) within 6 months; the secondary outcomes were prescribing changes for HF or IHD. RESULTS: A total of 171 patients participated in the study; 87 were allocated to the intervention, whereas 84 were assigned to the control group. The median age of the participants was 75 years; 103 (60%) were female, 54 (32%) had HF, and 117 (68%) had IHD. Overall, 21 (24%) intervention patients started receiving an efficacious medication within 6 months, as compared with 15 (18%) control subjects (relative risk of improvement 1.32, 95% CI 0.73-2.40, P = .31). In the HF subgroup, 38% of the intervention patients started receiving an ACE inhibitor or ARB therapy, as compared with 20% of control subjects (relative risk of improvement 1.90, 95% CI 0.76-4.72, P = .15). In the IHD subgroup, 17% of the intervention patients and 17% of the control subjects started receiving statin therapy (P = .97). CONCLUSIONS: The influence of local opinion leaders may be useful for improving the quality of cardiovascular prescribing in the community, but the benefits are likely modest and may be disease specific. Further studies on this method are warranted.
RCT Entities:
BACKGROUND: Local opinion leaders are educationally and socially influential physicians. Although they can accelerate the adoption of new evidence in hospitals, their impact on the quality of prescribing for outpatients has only been examined by a few studies. We hypothesized that an intervention consisting of patient-specific one-page evidence summaries, generated and endorsed by local opinion leaders, would improve prescribing of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in heart failure (HF) and that of statins in ischemic heart disease (IHD). METHODS: We conducted a community-based randomized controlled trial in patients with HF (not receiving ACE inhibitors or ARBs) and those with IHD (not receiving statins) who were recruited from 40 pharmacies and allocated either to the opinion leader intervention or to usual care based on randomization of their primary care physician. The primary outcome was an increase in the use of efficacious therapies (ACE inhibitors or ARBs in HF and statins in IHD) within 6 months; the secondary outcomes were prescribing changes for HF or IHD. RESULTS: A total of 171 patients participated in the study; 87 were allocated to the intervention, whereas 84 were assigned to the control group. The median age of the participants was 75 years; 103 (60%) were female, 54 (32%) had HF, and 117 (68%) had IHD. Overall, 21 (24%) intervention patients started receiving an efficacious medication within 6 months, as compared with 15 (18%) control subjects (relative risk of improvement 1.32, 95% CI 0.73-2.40, P = .31). In the HF subgroup, 38% of the intervention patients started receiving an ACE inhibitor or ARB therapy, as compared with 20% of control subjects (relative risk of improvement 1.90, 95% CI 0.76-4.72, P = .15). In the IHD subgroup, 17% of the intervention patients and 17% of the control subjects started receiving statin therapy (P = .97). CONCLUSIONS: The influence of local opinion leaders may be useful for improving the quality of cardiovascular prescribing in the community, but the benefits are likely modest and may be disease specific. Further studies on this method are warranted.
Authors: Gerd Flodgren; Elena Parmelli; Gaby Doumit; Melina Gattellari; Mary Ann O'Brien; Jeremy Grimshaw; Martin P Eccles Journal: Cochrane Database Syst Rev Date: 2011-08-10
Authors: Finlay A McAlister; Miriam Fradette; Sumit R Majumdar; Randall Williams; Michelle Graham; James McMeekin; William A Ghali; Ross T Tsuyuki; Merril L Knudtson; Jeremy Grimshaw Journal: CMAJ Date: 2009-11-23 Impact factor: 8.262
Authors: Jonathan G Howlett; Robert S McKelvie; Jeannine Costigan; Anique Ducharme; Estrellita Estrella-Holder; Justin A Ezekowitz; Nadia Giannetti; Haissam Haddad; George A Heckman; Anthony M Herd; Debra Isaac; Simon Kouz; Kori Leblanc; Peter Liu; Elizabeth Mann; Gordon W Moe; Eileen O'Meara; Miroslav Rajda; Samuel Siu; Paul Stolee; Elizabeth Swiggum; Shelley Zeiroth Journal: Can J Cardiol Date: 2010-04 Impact factor: 5.223
Authors: Finlay A McAlister; Sumit R Majumdar; Rajdeep S Padwal; Miriam Fradette; Ann Thompson; Ross Tsuyuki; Steven A Grover; Naeem Dean; Ashfaq Shuaib Journal: Implement Sci Date: 2010-04-12 Impact factor: 7.327
Authors: Sumit R Majumdar; Jeffrey A Johnson; Finlay A McAlister; Debbie Bellerose; Anthony S Russell; David A Hanley; Don W Morrish; Walter P Maksymowych; Brian H Rowe Journal: CMAJ Date: 2008-02-26 Impact factor: 8.262
Authors: A Cranney; M Lam; L Ruhland; R Brison; M Godwin; M M Harrison; M B Harrison; T Anastassiades; J M Grimshaw; I D Graham Journal: Osteoporos Int Date: 2008-07-16 Impact factor: 4.507
Authors: Alain G Bertoni; Denise E Bonds; Haiying Chen; Patricia Hogan; Lenore Crago; Erica Rosenberger; Ann Hiott Barham; C Randall Clinch; David C Goff Journal: Arch Intern Med Date: 2009-04-13