Rational Prescribing in Primary Care (RaPP) Economic Evaluation of an Intervention to Improve Professional Practice 英文参考文献.docVIP

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Rational Prescribing in Primary Care (RaPP) Economic Evaluation of an Intervention to Improve Professional Practice 英文参考文献.doc

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Rational Prescribing in Primary Care (RaPP) Economic Evaluation of an Intervention to Improve Professional Practice 英文参考文献

o PL SMEDICINE RationalPrescribinginPrimaryCare(RaPP): EconomicEvaluationofanIntervention toImproveProfessionalPractice Atle Fretheim*,Morten Aaserud, Andrew D.Oxman NorwegianKnowledgeCentreforHealthServices,Oslo,Norway Funding:Thestudywasfundedby theNorwegianMinistryofHealth, theNorwegianDirectoratefor HealthandSocialAffairs,andthe NorwegianKnowledgeCentrefor HealthServices.Thefunding ABSTRACT Background Interventions designed to narrow the gap between research findings and clinical practice maybeeffective,butalsocostly.Economicevaluationsarenecessarytojudgewhethersuch interventions are worth the effort. We have evaluated the economic effects of a tailored interventiontosupporttheimplementationofguidelinesfortheuseofantihypertensiveand cholesterol-loweringdrugs.Thetailoredinterventionwasevaluatedinarandomizedtrial,and wasshowntosignificantlyincreasetheuseofthiazidesforpatientsstartedonantihypertensive medication,buthadlittleornoimpactonotheroutcomes.Theincreaseduseofthiazideswas notexpectedtohaveanimpactonhealthoutcomes. agencieshadnoinfluenceonthe designorconductofthestudy. CompetingInterests:AFandADO wereresponsiblefortheRaPPtrial, whichwasanevaluationofthe interventioninquestion.MAhas previouslycarriedoutshort-term pharmacoeconomicprojectsforthe NationalInsuranceServiceandthe NorwegianMedicinesAgency.From 1997to1999MAworkedfora privatecompany,Brevreklame, doingmarketresearchfor MethodsandFindings Weperformedcost-minimizationandcost-effectivenessanalysesondatafromarandomized trialinvolving146generalpracticesfromtwogeographicalareasinNorway.Eachpracticewas randomizedtoeitherthetailoredintervention(70practices;257physicians)orcontrolgroup (69 practices; 244 physicians). Only patients that were being started on antihypertensive medicationwereincludedintheanalyses.Amultifacetedinterventionwastailoredtoaddress identifiedbarriers tochange. Keycomponents werean educational outreachvisit with audit and feedback, and computerized reminders. Pharmacists conducted the v