BACKGROUND: International concern about quality of medical care has led to intensive study of interventions to ensure care is consistent with best evidence. Simple, inexpensive, feasible and effective interventions remain limited. OBJECTIVE: We examined the impact of one-sentence evidence summaries appended to consultants' letters to primary care practitioners on adherence of the practitioners to recommendations made by the consultants regarding medication for patients with chronic medical problems. DESIGN: Cluster-randomised trial. SETTING: Secondary/primary care interface (urban district hospital/referral practices). PARTICIPANTS: 178 practices received one or more discharge letters with evidence summaries. The 66 practices in the intervention group provided feedback on 172 letters, and the 56 practices in the control group provided feedback on 96 letters. RESULTS: Appending an evidence summary to discharge letters resulted in a decrease in non-adherence to discharge medication from 29.6% to 18.5% (difference adjusted for underlying medical condition 12.5%; p = 0.039). Among the five possible reasons for discontinuing discharge medication, the evidence summaries seemed to have the largest impact on budget-related reasons for discontinuation (2.6% in the intervention versus 10.7% in the control group (p = 0.052)). Most clinicians (72%) were enthusiastic about continuing receiving evidence summaries with discharge letters in routine care. CONCLUSIONS: The one-sentence evidence summary is a simple, inexpensive, well-accepted intervention that may improve primary care practitioners' adherence to evidence-based consultant recommendations.
RCT Entities:
BACKGROUND: International concern about quality of medical care has led to intensive study of interventions to ensure care is consistent with best evidence. Simple, inexpensive, feasible and effective interventions remain limited. OBJECTIVE: We examined the impact of one-sentence evidence summaries appended to consultants' letters to primary care practitioners on adherence of the practitioners to recommendations made by the consultants regarding medication for patients with chronic medical problems. DESIGN: Cluster-randomised trial. SETTING: Secondary/primary care interface (urban district hospital/referral practices). PARTICIPANTS: 178 practices received one or more discharge letters with evidence summaries. The 66 practices in the intervention group provided feedback on 172 letters, and the 56 practices in the control group provided feedback on 96 letters. RESULTS: Appending an evidence summary to discharge letters resulted in a decrease in non-adherence to discharge medication from 29.6% to 18.5% (difference adjusted for underlying medical condition 12.5%; p = 0.039). Among the five possible reasons for discontinuing discharge medication, the evidence summaries seemed to have the largest impact on budget-related reasons for discontinuation (2.6% in the intervention versus 10.7% in the control group (p = 0.052)). Most clinicians (72%) were enthusiastic about continuing receiving evidence summaries with discharge letters in routine care. CONCLUSIONS: The one-sentence evidence summary is a simple, inexpensive, well-accepted intervention that may improve primary care practitioners' adherence to evidence-based consultant recommendations.
Authors: J M Grimshaw; L Shirran; R Thomas; G Mowatt; C Fraser; L Bero; R Grilli; E Harvey; A Oxman; M A O'Brien Journal: Med Care Date: 2001-08 Impact factor: 2.983
Authors: J M Grimshaw; R E Thomas; G MacLennan; C Fraser; C R Ramsay; L Vale; P Whitty; M P Eccles; L Matowe; L Shirran; M Wensing; R Dijkstra; C Donaldson Journal: Health Technol Assess Date: 2004-02 Impact factor: 4.014
Authors: J A Osheroff; D E Forsythe; B G Buchanan; R A Bankowitz; B H Blumenfeld; R A Miller Journal: Ann Intern Med Date: 1991-04-01 Impact factor: 25.391
Authors: Annette J Berendsen; Annegriet Kuiken; Wim H G M Benneker; Betty Meyboom-de Jong; Theo B Voorn; Jan Schuling Journal: BMC Health Serv Res Date: 2009-08-08 Impact factor: 2.655