A trial of education, prompts, and opinion leaders to improve prescription of lipid modifying therapy by primary care physicians for patients with ischemic heart disease

H. E. Bloomfield, D. B. Nelson, Michelle van Ryn, B. J. Neil, N. J. Koets, J. N. Basile, F. F. Samaha, R. Kaul, J. L. Mehta, D. Bouland

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Recent clinical trials indicate that treatment with lipid modifying therapy improves outcomes in patients with ischemic heart disease (IHD) and low levels of high density lipoprotein (HDL) cholesterol. The results of these trials, however, have not been widely implemented in clinical practice. Objectives: To develop and test an intervention designed to increase the rate of prescription of lipid modifying therapy and to determine the relative effectiveness of three different prompts (progress notes, patient letters, or computer chart reminders). Methods: The study was conducted in 11 US Department of Veterans Affairs Medical Centers. The effect of the intervention on the proportion of eligible patients receiving lipid modifying therapy was compared between five intervention sites and six matched control sites using a controlled before and after study design. Additionally, 92 providers within the intervention clinics were randomized to receive one of the three prompts. Data were analyzed using logistic regression modeling which incorporated terms to account for the clustered nature of the data. Results: At the intervention sites the prescription rate increased from 8.3% during the pre-intervention period to 39.1% during the intervention (OR = 6.5, 95% CI 5.2 to 8.2, p<0.0001) but remained unchanged at the control sites. The interaction between group (control v intervention) and time period was highly significant (p<0.0001). The adjusted odds of receiving a prescription during the intervention period was 3.1 times higher at the intervention sites than at the control sites (95% CI 2.1 to 4.7). Overall, there was no significant difference in prescription rates among the three prompt groups. However, there was a significant interaction between prompt group and site, indicating that the efficacy of the prompts differed by site. Conclusion: An intervention for primary care providers consisting of an educational workshop, opinion leader influence, and prompts substantially increased the prescription rate of lipid modifying therapy.

Original languageEnglish (US)
Pages (from-to)258-263
Number of pages6
JournalQuality and Safety in Health Care
Volume14
Issue number4
DOIs
StatePublished - Aug 1 2005
Externally publishedYes

Fingerprint

Primary Care Physicians
Myocardial Ischemia
Prescriptions
Lipids
Education
Therapeutics
United States Department of Veterans Affairs
HDL Cholesterol
Primary Health Care
Logistic Models
Clinical Trials
Control Groups

ASJC Scopus subject areas

  • Health Policy

Cite this

A trial of education, prompts, and opinion leaders to improve prescription of lipid modifying therapy by primary care physicians for patients with ischemic heart disease. / Bloomfield, H. E.; Nelson, D. B.; van Ryn, Michelle; Neil, B. J.; Koets, N. J.; Basile, J. N.; Samaha, F. F.; Kaul, R.; Mehta, J. L.; Bouland, D.

In: Quality and Safety in Health Care, Vol. 14, No. 4, 01.08.2005, p. 258-263.

Research output: Contribution to journalArticle

Bloomfield, H. E. ; Nelson, D. B. ; van Ryn, Michelle ; Neil, B. J. ; Koets, N. J. ; Basile, J. N. ; Samaha, F. F. ; Kaul, R. ; Mehta, J. L. ; Bouland, D. / A trial of education, prompts, and opinion leaders to improve prescription of lipid modifying therapy by primary care physicians for patients with ischemic heart disease. In: Quality and Safety in Health Care. 2005 ; Vol. 14, No. 4. pp. 258-263.
@article{06dcc1b24dad4312ac3d255644cf8ed4,
title = "A trial of education, prompts, and opinion leaders to improve prescription of lipid modifying therapy by primary care physicians for patients with ischemic heart disease",
abstract = "Background: Recent clinical trials indicate that treatment with lipid modifying therapy improves outcomes in patients with ischemic heart disease (IHD) and low levels of high density lipoprotein (HDL) cholesterol. The results of these trials, however, have not been widely implemented in clinical practice. Objectives: To develop and test an intervention designed to increase the rate of prescription of lipid modifying therapy and to determine the relative effectiveness of three different prompts (progress notes, patient letters, or computer chart reminders). Methods: The study was conducted in 11 US Department of Veterans Affairs Medical Centers. The effect of the intervention on the proportion of eligible patients receiving lipid modifying therapy was compared between five intervention sites and six matched control sites using a controlled before and after study design. Additionally, 92 providers within the intervention clinics were randomized to receive one of the three prompts. Data were analyzed using logistic regression modeling which incorporated terms to account for the clustered nature of the data. Results: At the intervention sites the prescription rate increased from 8.3{\%} during the pre-intervention period to 39.1{\%} during the intervention (OR = 6.5, 95{\%} CI 5.2 to 8.2, p<0.0001) but remained unchanged at the control sites. The interaction between group (control v intervention) and time period was highly significant (p<0.0001). The adjusted odds of receiving a prescription during the intervention period was 3.1 times higher at the intervention sites than at the control sites (95{\%} CI 2.1 to 4.7). Overall, there was no significant difference in prescription rates among the three prompt groups. However, there was a significant interaction between prompt group and site, indicating that the efficacy of the prompts differed by site. Conclusion: An intervention for primary care providers consisting of an educational workshop, opinion leader influence, and prompts substantially increased the prescription rate of lipid modifying therapy.",
author = "Bloomfield, {H. E.} and Nelson, {D. B.} and {van Ryn}, Michelle and Neil, {B. J.} and Koets, {N. J.} and Basile, {J. N.} and Samaha, {F. F.} and R. Kaul and Mehta, {J. L.} and D. Bouland",
year = "2005",
month = "8",
day = "1",
doi = "10.1136/qshc.2004.012617",
language = "English (US)",
volume = "14",
pages = "258--263",
journal = "BMJ Quality and Safety",
issn = "2044-5415",
publisher = "BMJ Publishing Group",
number = "4",

}

TY - JOUR

T1 - A trial of education, prompts, and opinion leaders to improve prescription of lipid modifying therapy by primary care physicians for patients with ischemic heart disease

AU - Bloomfield, H. E.

AU - Nelson, D. B.

AU - van Ryn, Michelle

AU - Neil, B. J.

AU - Koets, N. J.

AU - Basile, J. N.

AU - Samaha, F. F.

AU - Kaul, R.

AU - Mehta, J. L.

AU - Bouland, D.

PY - 2005/8/1

Y1 - 2005/8/1

N2 - Background: Recent clinical trials indicate that treatment with lipid modifying therapy improves outcomes in patients with ischemic heart disease (IHD) and low levels of high density lipoprotein (HDL) cholesterol. The results of these trials, however, have not been widely implemented in clinical practice. Objectives: To develop and test an intervention designed to increase the rate of prescription of lipid modifying therapy and to determine the relative effectiveness of three different prompts (progress notes, patient letters, or computer chart reminders). Methods: The study was conducted in 11 US Department of Veterans Affairs Medical Centers. The effect of the intervention on the proportion of eligible patients receiving lipid modifying therapy was compared between five intervention sites and six matched control sites using a controlled before and after study design. Additionally, 92 providers within the intervention clinics were randomized to receive one of the three prompts. Data were analyzed using logistic regression modeling which incorporated terms to account for the clustered nature of the data. Results: At the intervention sites the prescription rate increased from 8.3% during the pre-intervention period to 39.1% during the intervention (OR = 6.5, 95% CI 5.2 to 8.2, p<0.0001) but remained unchanged at the control sites. The interaction between group (control v intervention) and time period was highly significant (p<0.0001). The adjusted odds of receiving a prescription during the intervention period was 3.1 times higher at the intervention sites than at the control sites (95% CI 2.1 to 4.7). Overall, there was no significant difference in prescription rates among the three prompt groups. However, there was a significant interaction between prompt group and site, indicating that the efficacy of the prompts differed by site. Conclusion: An intervention for primary care providers consisting of an educational workshop, opinion leader influence, and prompts substantially increased the prescription rate of lipid modifying therapy.

AB - Background: Recent clinical trials indicate that treatment with lipid modifying therapy improves outcomes in patients with ischemic heart disease (IHD) and low levels of high density lipoprotein (HDL) cholesterol. The results of these trials, however, have not been widely implemented in clinical practice. Objectives: To develop and test an intervention designed to increase the rate of prescription of lipid modifying therapy and to determine the relative effectiveness of three different prompts (progress notes, patient letters, or computer chart reminders). Methods: The study was conducted in 11 US Department of Veterans Affairs Medical Centers. The effect of the intervention on the proportion of eligible patients receiving lipid modifying therapy was compared between five intervention sites and six matched control sites using a controlled before and after study design. Additionally, 92 providers within the intervention clinics were randomized to receive one of the three prompts. Data were analyzed using logistic regression modeling which incorporated terms to account for the clustered nature of the data. Results: At the intervention sites the prescription rate increased from 8.3% during the pre-intervention period to 39.1% during the intervention (OR = 6.5, 95% CI 5.2 to 8.2, p<0.0001) but remained unchanged at the control sites. The interaction between group (control v intervention) and time period was highly significant (p<0.0001). The adjusted odds of receiving a prescription during the intervention period was 3.1 times higher at the intervention sites than at the control sites (95% CI 2.1 to 4.7). Overall, there was no significant difference in prescription rates among the three prompt groups. However, there was a significant interaction between prompt group and site, indicating that the efficacy of the prompts differed by site. Conclusion: An intervention for primary care providers consisting of an educational workshop, opinion leader influence, and prompts substantially increased the prescription rate of lipid modifying therapy.

UR - http://www.scopus.com/inward/record.url?scp=23644451930&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=23644451930&partnerID=8YFLogxK

U2 - 10.1136/qshc.2004.012617

DO - 10.1136/qshc.2004.012617

M3 - Article

VL - 14

SP - 258

EP - 263

JO - BMJ Quality and Safety

JF - BMJ Quality and Safety

SN - 2044-5415

IS - 4

ER -