Evidence based educational outreach visits:: effects on prescriptions of non-steroidal anti-inflammatory drugs

Aims: To evaluate the effectiveness of an evidence based group educational outreach visit on prescription patterns of non-steroidal anti-inflammatory drugs (NSAIDs) in primary care. Design: Randomised controlled simple blind trial, with randomisation into three groups: experimental (evidence based educational outreach visit), placebo (conventional education session), and control (without intervention). Setting: The 24 primary care centres of the National Institute of Healthcare Network in a rural province of Aragon, Spain. Participants: The 24 primary health care teams of the network, with 158 general practitioners (GPs). The teams were randomised into the groups, experimental (8 teams, 48 GPs), placebo (8 teams, 54 GPs), and control (8 teams, 56 GPs). Intervention: Experimental group: one group educational outreach visit, conveying data based on a systematic review of the literature that was reinforced with printed material; placebo group: one non-structured educational session; control group: no intervention. Both educational sessions emphasised that there are no differences in the effectiveness of the NSAIDs reviewed (diclofenac, piroxicam, and tenoxicam); a recommendation was made to prescribe diclofenac over tenoxicam because of price differences. Main outcome measures: Changes in the number of packages prescribed for each of the drugs and changes in the cost per package of NSAIDs prescribed during the six months before, and after the intervention. Results: There were no differences in the basal characteristics of the three groups, except for the number of prescriptions during the six months before the intervention. Prescriptions for NSAIDs decreased homogeneously in the three groups. For tenoxicam, the experimental group reduced prescriptions by 22.5% (95%Cl: 34.42 to -10.76), compared with a reduction of 9.78% (95%Cl: -17.70 to -1.86) in the placebo group and an increase of 14.44% (95%Cl: 5.22 to 23.66) in the control group. The average cost per prescription decreased by 1.91% (95%Cl: -0.33% to -3.49%) in the experimental group, 0.16% (95%Cl: -0.27% to -2.93%) in the placebo group, and rose by 1.76% (95%Cl: 0.35% to 3.17%) in the control group. Conclusions: Evidence based educational outreach visits are more effective than no intervention at all. Results suggest that evidence based educational outreach visits are incrementally more effective than conventional educational sessions, which in turn are more effective than no intervention at all.