Group versus individual academic detailing to improve the use of antihypertensive medications in primary care: a cluster-randomized controlled trial
Open accessAbstract
Purpose To compare group versus individual academic detailing to increase diuretic or beta-blocker use in hypertension.Methods We conducted a cluster-randomized controlled trial in a large health maintenance organization. Subjects (N=9820) were patients with newly treated hypertension in the year preceding the intervention (N=3692), the 9 months following the intervention (N=3556), and the second year following intervention (N=2572). We randomly allocated 3 practice sites to group detailing (N=227 prescribers), 3 to individual detailing (N=235 prescribers), and 3 to usual care (N=319 prescribers). Individual detailing entailed a physician-educator meeting individually with clinicians to address barriers to prescribing guideline-recommended medications. The group detailing intervention incorporated the same social marketing principles in small groups of clinicians.Results In the first year following the intervention, the rates of diuretic or beta-blocker use increased by 13.2% in the group detailing practices, 12.5% in the individual detailing practices, and 6.2% in the usual care practices. As compared with usual care practices, diuretic or beta-blocker use was more likely in group detailing practices (adjusted odds ratio (OR), 1.40; 95% confidence interval (CI), 1.11 - 1.76) and individual detailing practices (adjusted OR, 1.30; 95% CI, 0.95 - 1.79). Neither intervention affected blood pressure control. Two years following this single-visit intervention, there was still a trend suggesting a persistent effect of individual (OR, 1.22; 95% CI, 0.92 - 1.62), but not group, detailing (OR, 1.06; 95% CI, 0.80 - 1.39), as compared with usual care.Conclusion Both group and individual academic detailing improved antihypertensive prescribing over and above usual care but may require reinforcement to sustain improvements.
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In Simon 2005, overall risk of bias was unclear.
“Risk of bias overall Unclear risk 4 unclear risk criteria”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Simon 2005
In Simon 2005, blinding of outcome assessment was at unclear risk of bias.
“Blinding of outcome assessment (detection bias) All outcomes Unclear risk The method of collecting prescribing data is not clear, but was probably from an electronic medical record”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Simon 2005
In Simon 2005, contamination was at low risk of bias.
“Contamination Low risk Practices were randomised”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Simon 2005
In Simon 2005, allocation concealment was at unclear risk of bias.
“Allocation concealment (selection bias) Unclear risk No details given”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Simon 2005
In Simon 2005, selective reporting was at low risk of bias.
“Selective reporting (reporting bias) Low risk Appropriate outcomes reported”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Simon 2005
In Simon 2005, other bias was at unclear risk of bias.
“Other bias Unclear risk The study took place in a single health maintenance organisation and contamination may be a risk. Baseline adherence was higher than national figures”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Simon 2005
In Simon 2005, baseline characteristics were at low risk of bias.
“Baseline characteristics Low risk More physicians in the control group were male. Otherwise, patient and physician characteristics were similar between groups (adjusted for)”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Simon 2005
In Simon 2005, baseline outcomes were at low risk of bias.
“Baseline outcomes Low risk Baseline outcomes similar”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Simon 2005
In Simon 2005, incomplete outcome data was at low risk of bias.
“Incomplete outcome data (attrition bias) All outcomes Low risk Each time period had a different cohort of patients”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Simon 2005
In Simon 2005, random sequence generation was at unclear risk of bias.
“Random sequence generation (selection bias) Unclear risk No details given”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Simon 2005
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- Authors
- Simon, S. R., Majumdar, S. R., Prosser, L. A., Salem-Schatz, S., Warner, C., Kleinman, K., Miroshnik, I., & Soumerai, S. B.
- Affiliations
- Harvard University (US)
- Harvard Vanguard Medical Associates (US)
- Corresponding author
- Simon, Steven R.
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2005-05
- Volume
- 118
- Issue
- 5
- Pages
- 521-528
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2090487756
- Cited by
- 87
- References
- 35
- Citations by year
- 2026: 2 · 2024: 2 · 2023: 3 · 2022: 4 · 2021: 1 · 2020: 1 · 2019: 5 · 2018: 3 · 2016: 4 · 2015: 4 · 2014: 5 · 2013: 6 · 2012: 3
- FWCI
- 6.17
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- ScholarWorks@UMassAmherst (University of Massachusetts Amherst) (submittedVersion)
- Scholarworks (University of Massachusetts Amherst) (submittedVersion, other-oa)
- Funders
- Agency for Healthcare Research and Quality (U18 HS010391, U18 HS 12019)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- academic detailing, antihypertensive prescribing, hypertension, diuretics, beta-blockers, guideline adherence, social marketing, primary care, blood pressure control, health maintenance organizations
- MeSH terms
- Adrenergic beta-Antagonists, Adult, Aged, Antihypertensive Agents, Cost-Benefit Analysis, Diuretics, Drug Utilization, Education, Medical, Continuing, Female, Health Maintenance Organizations, Humans, Hypertension, Male, Middle Aged, New England, Primary Health Care, Logistic Models, Drug Costs, Practice Guidelines as Topic, Guideline Adherence, Social Marketing
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