Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2004

Open Access 01-12-2004 | Research article

Improving prescribing of antihypertensive and cholesterol-lowering drugs: a method for identifying and addressing barriers to change

Authors: Atle Fretheim, Andrew D Oxman, Signe Flottorp

Published in: BMC Health Services Research | Issue 1/2004

Login to get access

Abstract

Background

We describe a simple approach we used to identify barriers and tailor an intervention to improve pharmacological management of hypertension and hypercholesterolaemia. We also report the results of a post hoc exercise and survey we carried out to evaluate our approach for identifying barriers and tailoring interventions.

Methods

We used structured reflection, searched for other relevant trials, surveyed general practitioners and talked with physicians during pilot testing of the intervention. The post hoc exercise was carried out as focus groups of international researchers in the field of quality improvement in health care. The post hoc survey was done by telephone interviews with physicians allocated to the experimental group of a randomised trial of our multifaceted intervention.

Results

A wide range of barriers was identified and several interventions were suggested through structured reflection. The survey led to some adjustments. Studying other trials and pilot testing did not lead to changes in the design of the intervention. Neither the post hoc focus groups nor the post hoc survey revealed important barriers or interventions that we had not considered or included in our tailored intervention.

Conclusions

A simple approach to identifying barriers to change appears to have been adequate and efficient. However, we do not know for certain what we would have gained by using more comprehensive methods and we do not know whether the resulting intervention would have been more effective if we had used other methods. The effectiveness of our multifaceted intervention is under evaluation in a randomised controlled trial.
Appendix
Available only for authorised users
Literature
1.
Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, Grilli R, Harvey E, Oxman A, O'Brien MA: Changing provider behavior: an overview of systematic reviews of interventions. Med Care. 2001, 39: II2-45. 10.1097/00005650-200108002-00002.CrossRefPubMed
2.
Oxman AD, Thomson MA, Davis DA, Haynes RB: No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ. 1995, 153: 1423-1431.PubMedPubMedCentral
3.
Freemantle N, Harvey EL, Wolf F, Grimshaw JM, Grilli R, Bero LA: Printed educational materials: effects on professional practice and health care outcomes. In: The Cochrane Library. 2001, Oxford: Update Software, 4
4.
Oxman AD, Flottorp S: An overview of strategies to promote implementation of evidence base health care. Evidence Based Practice. 2001, 2nd: 101-119.
5.
Fretheim A, Oxman A, Treweek S, Bjørndal A: Rational Prescribing in Primary Care (RaPP-trial). A randomised trial of a tailored intervention to improve prescribing of antihypertensive and cholesterol-lowering drugs in general practice [ISRCTN48751230]. BMC Health Services Research. 2003, 3: 5-10.1186/1472-6963-3-5.CrossRefPubMedPubMedCentral
6.
Fretheim A, Bjørndal A, Oxman AD, Dyrdal A, Golding M, Ose L, Reikvam A, Teisberg P: Retningslinjer for medikamentell primærforebygging av hjerte- og karsykdom – hvem bør behandles? [Guidelines for pharmacological primary prevention of cardiovascular disease: who should be treated?]. Tidsskr Nor Laegeforen. 2002, 122: 2277-2281.PubMed
7.
Fretheim A, Bjørndal A, Oxman AD, Dyrdal A, Golding M, Ose L, Reikvam A, Teisberg P: Hvilke blodtrykkssenkende legemidler bør brukes for primærforebygging av hjerte- og karsykdommer? [Which antihypertensive drugs should be used in the primary prevention of cardiovascular disease?]. Tidsskr Nor Laegeforen. 2002, 122: 2283-2286.PubMed
8.
Fretheim A, Bjørndal A, Oxman AD, Dyrdal A, Golding M, Ose L, Reikvam A, Teisberg P: Hvilke kolesterolsenkende legemidler bør brukes for primærforebygging av hjerte- og karsykdommer? [Which cholesterol-lowering drugs should be used in the primary prevention of cardiovascular disease?]. Tidsskr Nor Laegeforen. 2002, 122: 2287-2288.PubMed
9.
Fretheim A, Havelsrud K, Flottorp S, Oxman AD: Påvirker takster og refusjonsregler praksis? [Do fees for service and regulations for reimbursement influence practice?]. Tidsskr Nor Laegeforen. 2003, 795-796.
10.
Norwegian Institute of Public Health: Drug Consumption in Norway 1997 – 2001. Oslo. 2002
11.
Svilaas A, Risberg K, Thoresen M, Ose L: Lipid treatment goals achieved in patients treated with statin drugs in Norwegian general practice. Am J Cardiol. 2000, 86: 1250-3. 10.1016/S0002-9149(00)01212-1. A6CrossRefPubMed
12.
Westheim A, Klemetsrud T, Tretli S, Stokke HP, Olsen H: Blood pressure levels in treated hypertensive patients in general practice in Norway. Blood Press. 2001, 10: 37-42. 10.1080/080370501750183372.CrossRefPubMed
13.
Flottorp S, Oxman AD, Havelsrud K, Treweek S, Herrin J: A cluster randomised trial of tailored interventions to improve the management of urinary tract infections and sore throat. BMJ. 2002, 325: 367-370. 10.1136/bmj.325.7360.367.CrossRefPubMedPubMedCentral
14.
Scheel IB, Hagen KB, Herrin J, Oxman AD: A randomized controlled trial of two strategies to implement active sick leave for patients with low back pain. Spine. 2002, 27: 561-566. 10.1097/00007632-200203150-00002.CrossRefPubMed
15.
Bass MJ, McWhinney IR, Donner A: Do family physicians need medical assistants to detect and manage hypertension?. CMAJ. 1986, 134: 1247-1255.PubMedPubMedCentral
16.
Rossi RA, Every NR: A computerized intervention to decrease the use of calcium channel blockers in hypertension. J Gen Intern Med. 1997, 12: 672-678. 10.1046/j.1525-1497.1997.07140.x.CrossRefPubMedPubMedCentral
17.
Goldberg HI, Wagner EH, Fihn SD, Martin DP, Horowitz CR, Christensen DB, Cheadle AD, Diehr P, Simon G: A randomized controlled trial of CQI teams and academic detailing: can they alter compliance with guidelines?. Jt Comm J Qual Improv. 1998, 24: 130-142.PubMed
18.
Maclure M, Dormuth C, Naumann T, McCormack J, Rangno R, Whiteside C, Wright JM: Influences of educational interventions and adverse news about calcium-channel blockers on first-line prescribing of antihypertensive drugs to elderly people in British Columbia. Lancet. 1998, 352: 943-948. 10.1016/S0140-6736(97)11390-3.CrossRefPubMed
19.
Aucott JN, Pelecanos E, Dombrowski R, Fuehrer SM, Laich J, Aron DC: Implementation of local guidelines for cost-effective management of hypertension. A trial of the firm system. J Gen Intern Med. 1996, 11: 139-146.CrossRefPubMed
20.
Montgomery AA, Fahey T, Peters TJ, MacIntosh C, Sharp DJ: Evaluation of computer based clinical decision support system and risk chart for management of hypertension in primary care: randomised controlled trial. BMJ. 2000, 320: 686-690. 10.1136/bmj.320.7236.686.CrossRefPubMedPubMedCentral
21.
Hetlevik I, Holmen J, Kruger O, Kristensen P, Iversen H: Implementing clinical guidelines in the treatment of hypertension in general practice. Blood Press. 1998, 7: 270-276. 10.1080/080370598437114.CrossRefPubMed
22.
Demakis JG, Beauchamp C, Cull WL, Denwood R, Eisen SA, Lofgren R, Nichol K, Woolliscroft J, Henderson WG: Improving residents' compliance with standards of ambulatory care: results from the VA Cooperative Study on Computerized Reminders. JAMA. 2000, 284: 1411-1416. 10.1001/jama.284.11.1411.CrossRefPubMed
23.
van der Weijden T, Grol RP, Knottnerus JA: Feasibility of a national cholesterol guideline in daily practice. A randomized controlled trial in 20 general practices. Int J Qual Health Care. 1999, 11: 131-137. 10.1093/intqhc/11.2.131.CrossRefPubMed
24.
25.
Soumerai SB, McLaughlin TJ, Gurwitz JH, Guadagnoli E, Hauptman PJ, Borbas C, Morris N, McLaughlin B, Gao X, Willison DJ, Asinger R, Gobel F: Effect of local medical opinion leaders on quality of care for acute myocardial infarction: a randomized controlled trial. JAMA. 1998, 279: 1358-1363. 10.1001/jama.279.17.1358.CrossRefPubMed
26.
A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995, 274: 1591-1598. 10.1001/jama.274.20.1591.
27.
Flottorp S, Oxman AD: Tailoring interventions to improve the management of urinary tract infections and sore throat: a pragmatic study using qualitative methods. BMC Health Services Research. 2003, 3: 3-10.1186/1472-6963-3-3.CrossRefPubMedPubMedCentral
28.
Evans D, Mellins R, Lobach K, Ramos-Bonoan C, Pinkett-Heller M, Wiesemann S, Klein I, Donahue C, Burke D, Levison M, Levin B, Zimmerman B, Clark N: Improving care for minority children with asthma: professional education in public health clinics. Pediatrics. 1997, 99: 157-164. 10.1542/peds.99.2.157.CrossRefPubMed
29.
Hux JE, Melady MP, DeBoer D: Confidential prescriber feedback and education to improve antibiotic use in primary care: a controlled trial. CMAJ. 1999, 161: 388-392.PubMedPubMedCentral
30.
Santoso B, Suryawati S, Prawaitasari JE: Small group intervention vs formal seminar for improving appropriate drug use. Soc Sci Med. 1996, 42: 1163-1168. 10.1016/0277-9536(95)00390-8.CrossRefPubMed
31.
Avorn J, Soumerai SB, Everitt DE, Ross-Degnan D, Beers MH, Sherman D, Salem-Schatz SR, Fields D: A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. N Engl J Med. 1992, 327: 168-173.CrossRefPubMed
32.
Majumdar SR, Soumerai SB, Lee M, Ross-Degnan D: Designing an intervention to improve the management of Helicobacter pylori infection. Jt Comm J Qual Improv. 2001, 27: 405-414.PubMed
33.
Avorn J, Soumerai SB: Improving drug-therapy decisions through educational outreach. A randomized controlled trial of academically based "detailing". N Engl J Med. 1983, 308: 1457-1463.CrossRefPubMed
34.
Leviton LC, Baker S, Hassol A, Goldenberg RL: An exploration of opinion and practice patterns affecting low use of antenatal corticosteroids. Am J Obstet Gynecol. 1995, 173: 312-316. 10.1016/0002-9378(95)90220-1.CrossRefPubMed
35.
Ross-Degnan D, Soumerai SB, Goel PK, Bates J, Makhulo J, Dondi N, Sutoto , Adi D, Ferraz-Tabor L, Hogan R: The impact of face-to-face educational outreach on diarrhoea treatment in pharmacies. Health Policy Plan. 1996, 11: 308-318.CrossRefPubMed
36.
Forsetlund L, Bjorndal A: Identifying barriers to the use of research faced by public health physicians in Norway and developing an intervention to reduce them. J Health Serv Res Policy. 2002, 7: 10-18. 10.1258/1355819021927629.CrossRefPubMed
37.
Scheel IB, Hagen KB, Oxman AD: Active sick leave for patients with back pain: all the players onside, but still no action. Spine. 2002, 27: 654-659. 10.1097/00007632-200203150-00016.CrossRefPubMed
38.
Baker R, Reddish S, Robertson N, Hearnshaw H, Jones B: Randomised controlled trial of tailored strategies to implement guidelines for the management of patients with depression in general practice. Br J Gen Pract. 2001, 51: 737-741.PubMedPubMedCentral
39.
Cranney M, Barton S, Walley T: Addressing barriers to change: an RCT of practice-based education to improve the management of hypertension in the elderly. Br J Gen Pract. 1999, 49: 522-526.PubMedPubMedCentral
Metadata
Title
Improving prescribing of antihypertensive and cholesterol-lowering drugs: a method for identifying and addressing barriers to change
Authors
Atle Fretheim
Andrew D Oxman
Signe Flottorp
Publication date
01-12-2004
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2004
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-4-23

Other articles of this Issue 1/2004

BMC Health Services Research 1/2004 Go to the issue

Research article

A randomised controlled trial to determine the effect on response of including a lottery incentive in health surveys [ISRCTN32203485]

Research article

How patient-physician encounters in critical medical situations affect trust: results of a national survey

Study protocol

Pharmaceutical care for elderly patients shared between community pharmacists and general practitioners: a randomised evaluation. RESPECT (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) [ISRCTN16932128]

Research article

Racial variations in processes of care for patients with community-acquired pneumonia

Research article

Effect of prize draw incentive on the response rate to a postal survey of obstetricians and gynaecologists: A randomised controlled trial. [ISRCTN32823119]

Technical advance

Do pediatric hospitalizations have a unique geography?