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Research Article

Rational Prescribing in Primary Care (RaPP): A Cluster Randomized Trial of a Tailored Intervention

  • Atle Fretheim mail,

    To whom correspondence should be addressed. E-mail: atle.fretheim@nokc.no

    Affiliation: Norwegian Knowledge Centre for Health Services, Oslo, Norway

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  • Andrew D Oxman,

    Affiliation: Norwegian Knowledge Centre for Health Services, Oslo, Norway

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  • Kari Håvelsrud,

    Affiliation: Norwegian Knowledge Centre for Health Services, Oslo, Norway

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  • Shaun Treweek,

    Affiliation: Tayside Centre for General Practice, University of Dundee, Dundee, United Kingdom

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  • Doris T Kristoffersen,

    Affiliation: Norwegian Knowledge Centre for Health Services, Oslo, Norway

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  • Arild Bjørndal

    Affiliation: Norwegian Knowledge Centre for Health Services, Oslo, Norway

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  • Published: June 06, 2006
  • DOI: 10.1371/journal.pmed.0030134

Reader Comments (2)

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What guidelines? Never saw them!

Posted by plosmedicine on 30 Mar 2009 at 23:55 GMT

Author: A D Gowdy
Position: Senior health-sector manager
Institution: UK
E-mail: RaPP@gowdy.clara.net
Submitted Date: June 09, 2006
Published Date: June 13, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

This study confirms yet again how difficult it is to change clinical practice. As a manager with a "big organisation" NHS background, more recently working in practices with GPs, I always was impressed by GPs' shameless ability to ignore incoming paperwork, often to the extent of trashing the envelope unopened, especially the big brown ones from the local health authority.

I now work for a pharmaceutical company (not in my mind a competing interest, but probably proper to declare!) where the ability to change practice is a key skill. When I compare the pharma approach to a health authority, there are some key differences. It is easy to deride the glossy advert approach, but this is simply the tip of the communications iceberg. There is immense attention to detail, the key evidence-based messages are tested, honed and polished and then are delivered via several channels repetitively. The channels include face-to-face delivery by the "detail men". Progress is tracked meticulously.

The expensive but effective pharma effort contrasts totally with the typical "issue of [local] guidelines" exercise which has usually been so slow and difficult in the gestation that credibility is low even before the rather dull photocopied paper is issued (by post, big brown envelope) and meets its predictable fate.

The authors say "Key components were an educational outreach visit with audit and feedback, and computerized reminders linked to the medical record system. Pharmacists conducted the visits." which feels a bit like a policing approach (another profession watching the GP) allied to computer direction, none of which feel particularly user-friendly. A non-audit nurse (or ex-drug-rep) calling briefly but frequently using the usual pens/mugs/PostIt reminder freebies might get a better response.

One study by Eve et al (1997) did look at applying pharma techniques to clinical change ("selling" Triple A therapy). It seemed to work. It may be worth bringing it back into focus.
...........
Reference:-
Eve R, et al (1997) Framework for Appropriate Care Throughout Sheffield (facts) project:
http://www.innovate.org.u...

No competing interests declared.