Rational Prescribing in Primary care (RaPP): process evaluation of an intervention to improve prescribing of antihypertensive and cholesterol-lowering drugs.

2.50
Hdl Handle:
http://hdl.handle.net/10143/39749
Title:
Rational Prescribing in Primary care (RaPP): process evaluation of an intervention to improve prescribing of antihypertensive and cholesterol-lowering drugs.
Authors:
Fretheim, Atle; Håvelsrud, Kari; Oxman, Andrew David
Citation:
Implementation science : IS 2006, 1:19
Additional Links:
http://www.implementationscience.com/content/1/1/19

Full metadata record

DC FieldValue Language
dc.contributor.authorFretheim, Atle-
dc.contributor.authorHåvelsrud, Kari-
dc.contributor.authorOxman, Andrew David-
dc.date.accessioned2008-10-27T13:04:24Z-
dc.date.available2008-10-27T13:04:24Z-
dc.date.issued2006-
dc.identifier.citationImplementation science : IS 2006, 1:19en
dc.identifier.issn1748-5908-
dc.identifier.pmid16934153-
dc.identifier.doi10.1186/1748-5908-1-19-
dc.identifier.urihttp://hdl.handle.net/10143/39749-
dc.description.abstractBACKGROUND: A randomised trial of a multifaceted intervention for improving adherence to clinical practice guidelines for the pharmacological management of hypertension and hypercholesterolemia increased prescribing of thiazides, but detected no impact on the use of cardiovascular risk assessment tools or achievement of treatment targets. We carried out a predominantly quantitative process evaluation to help explain and interpret the trial-findings. METHODS: Several data-sources were used including: questionnaires completed by pharmacists immediately after educational outreach visits, semi-structured interviews with physicians subjected to the intervention, and data extracted from their electronic medical records. Multivariate regression analyses were conducted to explore the association between possible explanatory variables and the observed variation across practices for the three main outcomes. RESULTS: The attendance rate during the educational sessions in each practice was high; few problems were reported, and the physicians were perceived as being largely supportive of the recommendations we promoted, except for some scepticism regarding the use of thiazides as first-line antihypertensive medication. Multivariate regression models could explain only a small part of the observed variation across practices and across trial-outcomes, and key factors that might explain the observed variation in adherence to the recommendations across practices were not identified. CONCLUSION: This study did not provide compelling explanations for the trial results. Possible reasons for this include a lack of statistical power and failure to include potential explanatory variables in our analyses, particularly organisational factors. More use of qualitative research methods in the course of the trial could have improved our understanding.en
dc.language.isoenen
dc.relation.urlhttp://www.implementationscience.com/content/1/1/19en
dc.subjectVDP::Medisinske Fag: 700::Helsefag: 800::Helsetjeneste- og helseadministrasjonsforskning: 806en
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Kardiologi: 771en
dc.subject.meshCardiovascular Diseasesen
dc.subject.meshAnticholesteremic Agentsen
dc.subject.meshAntihypertensive Agentsen
dc.subject.meshDrug Utilizationen
dc.subject.meshFamily Practiceen
dc.subject.meshGuideline Adherenceen
dc.subject.meshHealth Promotionen
dc.subject.meshHypertensionen
dc.subject.meshNorwayen
dc.subject.meshPhysician's Practice Patternsen
dc.subject.meshPractice Guidelines as Topicen
dc.subject.meshPrescriptions, Drugen
dc.subject.meshPrimary Health Careen
dc.subject.meshRisk Assessmenten
dc.subject.meshRisk Factorsen
dc.subject.meshResearch Designen
dc.titleRational Prescribing in Primary care (RaPP): process evaluation of an intervention to improve prescribing of antihypertensive and cholesterol-lowering drugs.en
dc.typeJournal articleen
dc.typepeer revieweden
dc.contributor.departmentNorwegian Knowledge Centre for the Health Services, PB 7004 St, Olavs plass, N-0130 Oslo, Norway. atle.fretheim@nokc.noen
dc.identifier.journalImplementation science : ISen
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