Table 2.
Study/Design/Guideline | n | Behavioral Outcome | Clinical Importance | p | Grade |
---|---|---|---|---|---|
Educational outreach | |||||
Ray 200115/RCT/ACR guidelines for management of hip and knee OA in the elderly | 209 solo physicians | Days of prescribed medication use; cessation of NSAID use; drug costs | All physicians randomized to intervention or control group (intent-to-treat analysis): | ||
7% decrease in the no. patients taking NSAID | < 0.001 | C | |||
7% reduction in no. days of NSAID use Subset of physicians who received full intervention (protocol completers): | < 0.001 | C | |||
15% increase in no. days of acetaminophen use vs control group | < 0.001 | B | |||
10% decrease in no. days of NSAID use | < 0.001 | C | |||
EBOR, Freemantle, 19997/RCT/prescribing guidelines for 3 conditions, including NSAID for nonspecific joint pain | 162 physicians | Reimbursed prescriptions in administrative database | 3% decrease in intervention group (patients managed according to guidelines for joint pain) vs control group | Not reported | C |
Peer-facilitated workshops | |||||
Rosemann 200720 3-arm clustered RCT/evidence-based strategies for management of OA | 75/503 GP | Changes in no. radiographs; no. referrals to orthopedics; no. prescriptions for analgesics and antiinflammatory drugs | Compared to control group: | ||
Peer group meetings: | |||||
7% decrease in radiographs | 0.05 | C | |||
9% increase in acetaminophen prescriptions | 0.01 | C | |||
Peer group meetings plus case-management; | |||||
23% decrease in orthopedic referrals | 0.04 | A | |||
9% decrease in radiographs | 0.03 | C | |||
8% increase in acetaminophen prescriptions | < 0.01 | C | |||
4% increase in NSAID prescriptions | 0.02 | C | |||
8% increase in opioid prescriptions | ≤ 0.01 | C | |||
Getting a Grip on Arthritis Study Glazier 200521 nonrandomized trial using cross-sectional data at 2 timepoints/OPOT guidelines for the management of OA and RA | 21/30 providers | No. provider referrals to rehabilitation | Referrals to community arthritis services (The Arthritis Society) increased from 0 to 60 in the intervention group vs 0 to 2 referrals in the control group | < 0.05 | B |
CURATA, Rahme 200523/RCT/guidelines for prescribing NSAID or acetaminophen for OA | 249 GP | Adequacy of prescribing of COX-2 inhibitors, NSAID, or acetaminophen from the Quebec provincial health database | 4% improvement in total prescribing in the workshop and workshop and decision tree group combined vs 2% in the control group | Not reported | C |
Verstappen 200324/Multicenter RCT/Dutch College of Primary Care Physicians guidelines for diagnostic test ordering | 174 GP | Total number of x-rays ordered per clinical problem | Mean number of x-rays for degenerative joint disease group decreased by 19% vs 9% in control group | 0.34 | C |
Audit and feedback interventions | |||||
Curtis 200526/cluster RCT/guidelines for monitoring and use of cytoprotective agents | 101 GP | Medical record review (audit) and feedback | CBC testing increased 52% from baseline vs 25% in control group; for creatinine testing, physicians in the control group increased the number of tests by 41% from baseline vs 0% in the intervention group | NS | C+ |
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ACR: American College of Rheumatology; OPOT: Ontario Program for Optimal Therapeutics; CBC: complete blood count; RCT: randomized controlled trial; NSAID: nonsteroidal antiinflammatory drugs; COX-2: cyclooxygenase-2; EBOR: Evidence-Based OutReach; GP: general practitioner.