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Rational Prescribing in Primary Care (RaPP) A Cluster Randomized Trial of a Tailored Intervention 英文参考文献.doc

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Rational Prescribing in Primary Care (RaPP) A Cluster Randomized Trial of a Tailored Intervention 英文参考文献

o PL SMEDICINE RationalPrescribinginPrimaryCare(RaPP): AClusterRandomizedTrialofaTailored Intervention Atle Fretheim1*,Andrew D.Oxman1,Kari Ha?velsrud1,Shaun Treweek2,Doris T.Kristoffersen1,Arild Bj?rndal1 1NorwegianKnowledgeCentreforHealthServices,Oslo,Norway,2TaysideCentreforGeneralPractice,UniversityofDundee,Dundee,UnitedKingdom Funding:Thestudywasfundedby theNorwegianMinistryofHealth, theNorwegianDirectoratefor HealthandSocialAffairs,andthe NorwegianKnowledgeCentrefor HealthServices.Thefunding ABSTRACT Background A gap exists between evidence and practice regarding the management of cardiovascular riskfactors.Thisgapcouldbenarrowedifsystematicallydevelopedclinicalpracticeguidelines were effectively implemented in clinical practice. We evaluated the effects of a tailored interventiontosupporttheimplementationofsystematicallydevelopedguidelinesfortheuse of antihypertensive and cholesterol-lowering drugs for the primary prevention of cardiovas- culardisease. agencieshadnoinfluenceonthe designorconductofthestudy. CompetingInterests:Allthe authorsare,orhavebeen,employed bytheNorwegiangovernment, whichhasasubstantialinterestin improvingprofessionalpracticein Norwayandincontainingthecosts ofhealthcare.Theclinicalpractice guidelinesandthestudydesign havenotbeenendorsedbythe governmentoranyother MethodsandFindings We conducted a cluster-randomized trial comparing a tailored intervention to passive disseminationofguidelinesin146generalpracticesintwogeographicalareasinNorway.Each practice was randomized to either the tailored intervention (70 practices; 257 physicians) or controlgroup(69practices;244physicians).Patientsstartedonmedicationforhypertensionor hypercholesterolemia during the study period and all patients already on treatment that consulted their physician during the trial were included. A multifaceted intervention was tailored to address identified barriers to change. Key components were an educational outreach visit with audit and feedback, and computeriz