Key result
Brief educational intervention fails to improve appropriate statin prescribing in primary care.
Why the study?
Many patients with elevated cardiovascular risk or cardiovascular disorders do not receive evidence-based statin prescriptions despite their proven benefit.
Does a brief educational intervention for primary care physicians improve the appropriate prescription of statins in patients > 35 years?
RCT (n=78,139)
Open-label
Cluster randomized
Yes
Does a brief educational intervention for primary care physicians improve the appropriate prescription of statins in patients > 35 years?
Odds Ratio: 0.95 (95% CI 0.93–0.98)
p-value: p=0.001
A brief educational intervention for primary care physicians failed to significantly change statin prescribing behavior in everyday practice.
Brief CV risk education does not improve statin prescribing appropriateness; challenges efficacy of simple implementation strategies and supports testing multifaceted interventions.
BACKGROUND: The prescription of statins is an evidence-based treatment to reduce the risk of cardiovascular events in patients with elevated cardiovascular risk or with a cardiovascular disorder (CVD). In spite of this, many of these patients do not receive statins. METHODS: We evaluated the impact of a brief educational intervention in cardiovascular prevention in primary care physicians' prescribing behaviour regarding statins beyond their participation in a randomised controlled trial (RCT). For this, prescribing data of all patients > 35 years who were counselled before and after the study period were analysed (each n > 75,000). Outcome measure was prescription of Hydroxymethylglutaryl-CoA Reductase Inhibitors (statins) corresponding to patients' overall risk for CVD. Appropriateness of prescribing was examined according to different risk groups based on the Anatomical Therapeutic Chemical Classification System (ATC codes). RESULTS: There was no consistent association between group allocation and statin prescription controlling for risk status in each risk group before and after study participation. However, we found a change to more significant drug configurations predicting the prescription of statins in the intervention group, which can be regarded as a small intervention effect. CONCLUSION: Our results suggest that an active implementation of a brief evidence-based educational intervention does not lead to prescription modifications in everyday practice. Physician's prescribing behaviour is affected by an established health care system, which is not easy to change. TRIAL REGISTRATION: ISRCTN71348772.
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Keller et al. (2013) conducted an RCT in Elevated cardiovascular risk (n=78,139). arribaTM educational intervention vs. Alternative continuing medical education topics was evaluated on Appropriateness of statin prescription after intervention (OR 0.95, 95% CI 0.93-0.98, p=0.001). An active implementation of a brief evidence-based educational intervention on global cardiovascular risk did not improve the appropriateness of statin prescribing in primary care.
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