Randomised controlled trial of educational package on management of menorrhagia in primary care: the Anglia menorrhagia education study

Objective To determine whether an educational package could influence the m anagement of menorrhagia, increase the appropriateness of choice of non-hor monal treatment, and reduce referral rates hom primary to secondary care. Design Randomised controlled trial. Setting General practices in East Anglia Subjects 100 practices (348 doctors) in primary care were recruited and ran domised to intervention(54) and control (46). Interventions An educational package based on principles of "academic detai ling" with independent academics was given in small practice based interact ive groups with a visual presentation, a printed evidence based summary, a graphic management flow Chart, and a follow up meeting at 6 months. Outcome measures All practices recorded consultation details, treatments of fered, and outcomes for women with regular heavy menstrual loss (menorrhagi a) over 1 year. Results 1001 consultation data sheets for menorrhagia were returned. There were significantly fewer referrals (20% v 29%; odds ratio 0.64; 95% confide nce interval 0.41 to 0.99) and a significantly higher use of tranexamic aci d (odds ratio 2.38; 1.61 to 3.49) in the intervention group but no overall difference in norethisterone treatment compared with controls. There were m ore referrals when tranexamic acid was given with norethisterone than when it was given alone. Those practices reporting fewer than 10 cases showed th e highest increase in prescribing of tranexamic acid. Conclusions The educational package positively influenced referral for meno rrhagia and treatment with appropriate non-hormonal drugs.