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Clinical Trial
. 1999 May 8;318(7193):1246-50.
doi: 10.1136/bmj.318.7193.1246.

Randomised controlled trial of educational package on management of menorrhagia in primary care: the Anglia menorrhagia education study

G R Fender  1 , A Prentice, T Gorst, R M Nixon, S W Duffy, N E Day, S K Smith
Affiliations
Clinical Trial

Randomised controlled trial of educational package on management of menorrhagia in primary care: the Anglia menorrhagia education study

G R Fender et al. BMJ. .

Abstract

Objective: To determine whether an educational package could influence the management of menorrhagia, increase the appropriateness of choice of non-hormonal treatment, and reduce referral rates from primary to secondary care.

Design: Randomised controlled trial.

Setting: General practices in East Anglia.

Subjects: 100 practices (348 doctors) in primary care were recruited and randomised to intervention (54) and control (46).

Interventions: An educational package based on principles of "academic detailing" with independent academics was given in small practice based interactive groups with a visual presentation, a printed evidence based summary, a graphic management flow chart, and a follow up meeting at 6 months.

Outcome measures: All practices recorded consultation details, treatments offered, and outcomes for women with regular heavy menstrual loss (menorrhagia) over 1 year.

Results: 1001 consultation data sheets for menorrhagia were returned. There were significantly fewer referrals (20% v 29%; odds ratio 0. 64; 95% confidence interval 0.41 to 0.99) and a significantly higher use of tranexamic acid (odds ratio 2.38; 1.61 to 3.49) in the intervention group but no overall difference in norethisterone treatment compared with controls. There were more referrals when tranexamic acid was given with norethisterone than when it was given alone. Those practices reporting fewer than 10 cases showed the highest increase in prescribing of tranexamic acid.

Conclusions: The educational package positively influenced referral for menorrhagia and treatment with appropriate non-hormonal drugs.

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Figures

Figure 1
Figure 1
Recruitment, randomisation, and retention of practices in study over time
Figure 2
Figure 2
Cases of menorrhagia reported against proportion referred to hospital from each practice. Equal numbers of cases were reported from practices returning more or fewer than 10 data sheets, thus allowing balanced comparison of reporting behaviour in terms of number of data sheets received and referral and treatment behaviour
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References

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