Outcomes of an educational-outreach service for community medical practitioners: non-steroidal anti-inflammatory drugs

Objective: Exploration of longer-term outcomes of an ongoing educational-ou treach service for community doctors. Design: Quasi-experimental, with parallel and historical comparisons. Setting: Since 1992, a teaching-hospital-based service has been providing a dvice and information on drugs and therapeutic strategies to community medi cal practitioners. Participants: 210 doctors practising in a particular area of metropolitan A delaide (79% general practitioners; 21% specialists). Interventions: Two surgery visits during 1992 focused on better use of pres cribed non-steroidal anti-Inflammatory drugs (NSAIDs). Subsequent visits on other topical therapeutic issues have occurred regularly. Main outcome measures: Doctor participation in the service; supply of presc ription NSAIDs; hospital admissions for gastrointestinal (GI) effects of NS AID use. Results: 89% of doctors practising within the service area received the fir st visit on NSAIDs and 86% received the second visit. More than 85% continu e to receive the service. Relative to a comparison area, aggregate reductio ns of 9% and 28%, respectively, were observed in two different measures of NSAID use. During an Ii-year observation period, a single change point in t he number of hospital admissions for GI disorders occurred in the service a rea, coinciding with delivery of the NSAID program. In the five years since the visits commenced, a 70% reduction in admissions was observed. No notab le changes in hospital admission rates occurred in the comparison area. Conclusions: A continuing education and support service for community medic al practitioners which uses principally academic detailing methods in its c ontact with doctors has contributed to sustained changes in prescribed NSAI D use over a five-year period. A focus on risk-minimisation in prescribing of NSAIDs appears to have contributed to reductions in hospitalisations for GI adverse events.