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Change in antihypertensive drug prescribing after guideline implementation: A controlled before and after study Full Text
BMC Family Practice, 08/26/2011
Clinical Guideline
Sipila R et al. – A multifaceted guideline implementation intervention does not necessarily lead to significant changes in prescribing performance. Rigorous planning of the interventions and quality projects and their evaluation are essential.
Methods- In this controlled before and after study, the effects of a multifaceted (education, audit and feedback, local care pathway) quality programme was evaluated.
- The intervention was carried out in a health centre between 2002 and 2003.
- From each health care unit (n=31), a doctor–nurse pair was trained to act as peer facilitators in the intervention.
- All antihypertensive drugs prescribed by 25 facilitator general practitioners (intervention GPs) and 53 control GPs were retrieved from the nationwide Prescription Register for three–month periods in 2001 and 2003.
- The proportions of patients receiving specific antihypertensive drugs and multiple antihypertensive drugs were measured before and after the intervention for three subgroups of hypertension patients: hypertension only, with coronary heart disease, and with diabetes.
- In all subgroups, the use of multiple concurrent medications increased.
- For intervention patients with hypertension only, the odds ratio (OR) was 1.12 (95% CI 0.99, 1.25; p=0.06) and for controls 1.13 (1.05, 1.21; p=0.002).
- Authors observed no statistically significant differences in the change in the prescribing of specific antihypertensive agents between the intervention and control groups.
- The use of agents acting on the renin–angiotensin–aldosterone system increased in all subgroups (hypertension only intervention patients OR 1.19 (1.06, 1.34; p=0.004) and controls OR 1.24 (1.15, 1.34; p<0.0001).