| Impact of opinion leader-endorsed evidence summaries on the quality of prescribing for patients with cardiovascular disease: a randomized controlled trial. | |
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MedLine Citation:
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PMID: 17174632 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Sumit R Majumdar; Ross T Tsuyuki; Finlay A McAlister |
Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: American heart journal Volume: 153 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2007 Jan |
Date Detail:
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Created Date: 2006-12-18 Completed Date: 2007-01-25 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 22.e1-8 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00175279; ISRCTN/ISRCTN26365328 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Alberta Angiotensin-Converting Enzyme Inhibitors / therapeutic use* Disease Management Feedback Female Heart Failure / drug therapy* Humans Interprofessional Relations Leadership Male Myocardial Ischemia / drug therapy* Physician's Practice Patterns* Quality of Health Care* Receptors, Angiotensin / antagonists & inhibitors* |
| Chemical | |
Reg. No./Substance:
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0/Angiotensin-Converting Enzyme Inhibitors; 0/Receptors, Angiotensin |
| Comments/Corrections | |
Comment In:
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Am Heart J. 2007 Jan;153(1):1-3
[PMID:
17174625
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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