Pharmaceutical Research

Both group and individual academic detailing can improve prescribing of antihypertensive medications

Academic detailing involves the use of trained individuals (usually physicians or clinical pharmacists) who conduct face-to-face visits with physicians and other prescribers to encourage adoption of a desired behavior (e.g., prescribing of a particular drug or treatment regimen). The use of individual or group academic detailing to address barriers to recommended prescribing of antihypertensive medications (use of beta-blockers and diuretics as first-line agents) improves antihypertensive prescribing practices, according to a recent study. The study was conducted by researchers participating in the HMO Research Network Center for Education and Research in Therapeutics (CERT), which is supported by the Agency for Healthcare Research and Quality (HS10391).

Steven R. Simon, M.D., M.P.H., of Harvard Medical School and Harvard Pilgrim Health Care, and his colleagues examined prescribing of antihypertensive medications for patients with newly treated hypertension who were treated at nine practice sites of a large HMO. The researchers randomly assigned three practice sites to group detailing (227 prescribers), three to individual detailing (235 prescribers), and three to usual care (319 prescribers). In the first year following academic detailing, absolute rates of use of diuretics or beta-blockers increased by 13.2 percent in the group detailing practices, 12.5 percent in the individual detailing practices, and 6.2 percent in the usual care practices (which received only a mailed practice guideline).

At 2 years after detailing, use of guideline-recommended medications over baseline was greater in the individual detailing practices (14.7 percent) than in group detailing practices (11.3 percent), which were not much different than increases in the usual care practices (10.1 percent). This may suggest a persistent effect of individual detailing but not group detailing. However, neither type of academic detailing had a clinically meaningful effect on blood pressure control.

See "Group versus individual academic detailing to improve the use of antihypertensive medications in primary care: A cluster-randomized controlled trial," by Dr. Simon, Sumit R. Majumdar, M.D., M.P.H., Lisa A. Prosser, Ph.D., and others, in the May 2005 American Journal of Medicine 118, pp. 521-528.

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