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Cited by 83Innovations in Medical EducationClinical practice guidelines implementationBlood Pressure and Hypertension Studies

Better Prescribing Project: a randomized controlled trial of the impact of case-based educational modules and personal prescribing feedback on prescribing for hypertension in primary care

Herbert, C. P·2004·Family Practice
DOI 10.1093/fampra/cmh515
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Abstract

OBJECTIVE: The purpose of this study was to assess the impacts of individualized prescribing feedback and interactive small group education aimed at encouraging evidence-based prescribing in family/general practice. METHODS: A two-by-two factorial randomized controlled trial was carried out involving 200 family physicians in British Columbia, Canada. The physicians met monthly in 28 peer learning groups within the Practice-Based Small Group (PBSG) learning programme. Personalized prescribing feedback related to hypertension was provided through 'prescribing portraits' which graphically displayed comparative rates of individual and peer group prescribing, together with a concise guide for evidence-based prescribing. A case-based educational module, containing the same evidence-based message, was discussed in small groups. Groups were matched and randomized into four arms of seven groups each: control (n = 56), prescribing portrait only (n = 48), educational module only (n = 47), both portrait and module (n = 49). The main outcome measure was changes in 'prescribing preferences' to new patients among those medications used to treat hypertension (i.e. probability that a patient would receive the evidence-based medication as first-line therapy). RESULTS: Using data from the provincial pharmacy registry (PharmaNet), prescribing preferences for antihypertensive agents were determined for all groups for a 6 month period before and after the interventions, based on 4394 patients receiving a first-line antihypertensive. Significant absolute increases in prescribing preference for thiazides were documented for both the module +0.068 (confidence interval [CI] 0.022-0.115) and the portrait +0.065 (CI 0.018-0.111). Preference in the group receiving both module and portrait increased by +0.115 (CI 0.040-0.189). CONCLUSIONS: Evidence-based educational interventions combining personalized prescribing feedback with interactive group discussion can lead to modest but meaningful changes in physician prescribing. Clear messages, proper trial design and sensitive outcomes are necessary to demonstrate these changes.

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  • Herbert 2004 found that combining feedback with problem-based learning groups in primary care had a greater effect on appropriate use of antihypertensives compared to feedback alone (adjusted RD = 7.4%; P value not reported).

    “Herbert 2004 compared combining feedback with problem‐based learning groups in primary care to feedback alone and found the combination had a greater effect on appropriate use of antihypertensives (adjusted RD = 7.4%; P value not reported).”

    From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as Herbert 2004

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Research works printed but not linked: 3

  1. Gill PS, Makela M, Vermeulen KM et al. Changing doctor prescribing behaviour: a review. 1998. In Effective Health Care: Getting Evidence into Practice. York: NHS Centre for Reviews and Dissemination, The University of York; 1999; 5: 1-16.
  2. Davis D, O'Brien MAT, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds and other continuing education activities change physician behavior or health outcomes? J Am Med Assoc 1999; 282: 867-874.
  3. Mazmanian PE, Davis D. Continuing medical education and the physician as a learner. J Am Med Assoc 2002; 288: 1057-1060.

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Authors
Herbert, C. P.
Affiliations
Western University (CA)
Corresponding author
Herbert, C. P
ORCID
Herbert, C. P
Venue
Family Practice
Publisher
Oxford University Press (OUP)
Published
2004-10-01
Volume
21
Issue
5
Pages
575-581
ISSN
  • 0263-2136 (ISSN-L)
  • 1460-2229
DOI
10.1093/fampra/cmh515
OpenAlex
W2098302682
Cited by
83
References
24
Citations by year
2025: 2 · 2024: 4 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 4 · 2019: 2 · 2018: 4 · 2017: 3 · 2015: 3 · 2014: 6 · 2013: 5 · 2012: 11
FWCI
6.45
Type
journal article
Language
en
Open access
closed
Locations
  • Family Practice (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
Health Canada
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords
prescribing feedback, hypertension, antihypertensive drugs, thiazide diuretics, evidence-based prescribing, case-based teaching, peer learning groups, physician training, primary care, first-line therapy
MeSH terms
Antihypertensive Agents, Benzothiadiazines, British Columbia, Diuretics, Education, Medical, Continuing, Family Practice, Feedback, Humans, Hypertension, Organizational Innovation, Practice Patterns, Physicians', Drug Prescriptions, Problem-Based Learning, Sodium Chloride Symporter Inhibitors

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