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Randomized Controlled Trial
. 2014 Oct 17;9(10):e109915.
doi: 10.1371/journal.pone.0109915. eCollection 2014.

Long term effectiveness on prescribing of two multifaceted educational interventions: results of two large scale randomized cluster trials

Nicola Magrini  1 , Giulio Formoso  1 , Oreste Capelli  2 , Emilio Maestri  1 , Francesco Nonino  1 , Barbara Paltrinieri  1 , Cinzia Del Giovane  3 , Claudio Voci  1 , Lucia Magnano  1 , Lisa Daya  2 , Anna Maria Marata  1 ; INDRA-NET study group
Collaborators, Affiliations
Randomized Controlled Trial

Long term effectiveness on prescribing of two multifaceted educational interventions: results of two large scale randomized cluster trials

Nicola Magrini et al. PLoS One. .

Abstract

Introduction: Information on benefits and risks of drugs is a key element affecting doctors' prescribing decisions. Outreach visits promoting independent information have proved moderately effective in changing prescribing behaviours.

Objectives: Testing the short and long-term effectiveness on general practitioners' prescribing of small groups meetings led by pharmacists.

Methods: Two cluster open randomised controlled trials (RCTs) were carried out in a large scale NHS setting. Ad hoc prepared evidence based material were used considering a therapeutic area approach--TEA, with information materials on osteoporosis or prostatic hyperplasia--and a single drug oriented approach--SIDRO, with information materials on me-too drugs of 2 different classes: barnidipine or prulifloxacin. In each study, all 115 Primary Care Groups in a Northern Italy area (2.2 million inhabitants, 1737 general practitioners) were randomised to educational small groups meetings, in which available evidence was provided together with drug utilization data and clinical scenarios. Main outcomes were changes in the six-months prescription of targeted drugs. Longer term results (24 and 48 months) were also evaluated.

Results: In the TEA trial, one of the four primary outcomes showed a reduction (prescription of alfuzosin compared to tamsulosin and terazosin in benign prostatic hyperplasia: prescribing ratio -8.5%, p = 0.03). Another primary outcome (prescription of risedronate) showed a reduction at 24 and 48 months (-7.6%, p = 0.02; and -9,8%, p = 0.03), but not at six months (-5.1%, p = 0.36). In the SIDRO trial both primary outcomes showed a statistically significant reduction (prescription of barnidipine -9.8%, p = 0.02; prescription of prulifloxacin -11.1%, p = 0.04), which persisted or increased over time.

Interpretation: These two cluster RCTs showed the large scale feasibility of a complex educational program in a NHS setting, and its potentially relevant long-term impact on prescribing habits, in particular when focusing on a single drug. National Health systems should invest in independent drug information programs.

Trial registration: Controlled-Trials.com ISRCTN05866587.

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Conflict of interest statement

Competing Interests: The authors have read the journal's policy and have the following conflicts: Since 2001, the Authors have been involved in the implementation of a pharmacist outreach visit programs in a few Health Districts of Emilia-Romagna, receiving organizational support and NHS funding from the corresponding Local Health Authorities. This does not alter the authors' adherence to PLOS ONE Editorial policies and criteria.

Figures

Figure 1
Figure 1. Flow-charts of the two cluster RCTs.
Figure 2
Figure 2. % differences in primary outcomes at 6 months (main analysis), 12, 24 and 48 months.
See this image and copyright information in PMC

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