AIM: Education increases proper use of blood pressure therapies in practice

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Stanford University researchers found that use of academic detailing activities—face-to-face education of clinicians by investigators trained to present trial findings and guidelines—was linked to the increased prescribing of thiazide-type diuretics for high blood pressure patients, according to a study published in the May 24 issue of the Archives of Internal Medicine.

“Many studies indicate that evidence-based recommendations diffuse into widespread community use only slowly and then incompletely. This failure to put scientific findings into practice not only compromises societal return on clinical trial investment, but also weakens the scientific basis of clinical care,” the authors wrote.

Randall S. Stafford, MD, PhD, an associate professor of medicine at the Stanford Prevention Research Center in Stanford, Calif., and colleagues evaluated the effects of the administration of thiazide-type diuretic prescriptions using results from the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack) clinical trial and the 7th report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7).

As part of the project, 147 investigators were trained to present the ALLHAT and the JNC7 guidelines as a means of achieving proper blood pressure control. The investigators, between 2004 and 2007, made presentations to 18,524 physicians who prescribe hypertension medications at 1,698 clinical sites.

According to the study, prescribing of these medications did not increase between 2004 and 2008, but results did show that the administration of these drugs were highest in places were academic detailing took place, and, in fact, increased by 8.6 percent—from 37.9 percent to 46.5 percent.

In geographic areas where academic detailing was moderate the administration of these drugs increased by only 2 percent and for areas where the detailing was low their use decreased by 2 percent.

“Pharmacy dispensing data showed that thiazide-type diuretic prescribing increased by 8.7 percent in counties with Dissemination Project activities compared with 3.9 percent in those without activities.”

The researchers said that other factors including the role of thiazide-type diuretics “may have blunted the intervention’s impact.”

“Academic detailing has the potential to improve prescribing patterns but may require greater intensity to facilitate translation of clinical trials evidence into community practice,” the authors concluded.

The trial was funded by  the National Heart, Lung and Blood Institute.