Outcomes of an educational-outreach service for community medical practitioners: non-steroidal anti-inflammatory drugs

Abstract

Objective: Exploration of longer-term outcomes of an ongoing educational-outreach service for community doctors.

Design: Quasi-experimental, with parallel and historical comparisons.

Setting: Since 1992, a teaching-hospital-based service has been providing advice and information on drugs and therapeutic strategies to community medical practitioners.

Participants: 210 doctors practising in a particular area of metropolitan Adelaide (79% general practitioners; 21% specialists).

Interventions: Two surgery visits during 1992 focused on better use of prescribed non-steroidal anti-inflammatory drugs (NSAIDs). Subsequent visits on other topical therapeutic issues have occurred regularly.

Main outcome measures: Doctor participation in the service; supply of prescription NSAIDs; hospital admissions for gastrointestinal (GI) effects of NSAID use.

Results: 89% of doctors practising within the service area received the first visit on NSAIDs and 86% received the second visit. More than 85% continue to receive the service. Relative to a comparison area, aggregate reductions of 9% and 28%, respectively, were observed in two different measures of NSAID use. During an 11-year observation period, a single change point in the number of hospital admissions for GI disorders occurred in the service area, coinciding with delivery of the NSAID program. In the five years since the visits commenced, a 70% reduction in admissions was observed. No notable changes in hospital admission rates occurred in the comparison area.

Conclusions: A continuing education and support service for community medical practitioners which uses principally academic detailing methods in its contact with doctors has contributed to sustained changes in prescribed NSAID use over a five-year period. A focus on risk-minimisation in prescribing of NSAIDs appears to have contributed to reductions in hospitalisations for GI adverse events.