doi:10.1258/135581902320432769
© 2002 Royal Society of Medicine Press
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Original research |
Irwin Nazareth,
Nick Freemantle,
Catherine Duggan,
James Mason,
Andy Haines
Department of Primary Care and Population Science, Royal Free and University College Medical School, London, UK;
Department of General Practice, The University of Birmingham, Birmingham;
Academic Department of Pharmacy Practice, St Bartholomew’s Hospital, London;
Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne;
London School of Hygiene and Tropical Medicine, London, UK
Objectives: To identify the effect of a complex intervention (educational outreach visits by pharmacists) designed to change general practitioners’ (GPs’) prescribing on each step of a hypothesised pathway of change leading to the final primary trial outcome of change in prescribing.
Method: The study was undertaken in six health authorities inthe North of England and six in London. We described three stepsleading to this outcome: the general practices agreeing to participate;GPs in each practice attending the outreach visit conductedby the pharmacists; and the GPs’ prescribing practice beinginfluenced by these visits. The outcomes of each step were assessedusing a combination of quantitative and qualitative methods.
Results: Of the 102 practices randomly selected, 75 (73.5%)agreed to participate. The odds of all the doctors attendingthe outreach meeting in small practices (i.e. 1-2 partners)was 6.7 (95% CI: 4.4-23.5) compared with other practices (i.e.> 3 partners). Although the pharmacists reported that theyhad established a good rapport at 100 (72%) first visits andhad agreed management plans for 110 (79%) of these visits, theywere confident that the practice was likely to alter its prescribingin only 41% of these visits. Pharmacists’ and GPs’ satisfactionwith the outreach visits did not necessarily lead to prescribingchanges after the practice visit, and the GPs’ knowledge ofthe guidelines promoted by the pharmacists did not necessarilytranslate into changes in clinical practice. The main barriersto the implementation of guidelines identified by the pharmacistsat the follow-up visits were organisational difficulties, theGPs’ scepticism of the evidence presented to them and the doctors’lack of interest in changing their prescribing behaviour.
Conclusions: Although our study is limited by a post hoc ratherthan a pre hoc design, it provides a pragmatic approach to understandingthe factors influencing the pathway of change in prescribingbehaviour in response to academic outreach visits.
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