Improving adherence to dementia guidelines through education and opinion leaders - A randomized, controlled trial

Background: Educational methods that encourage physicians to adopt practice guidelines are needed. Objective: To evaluate an educational strategy to increase neurologists' ad herence to specialty society-endorsed practice recommendations. Design: Randomized, controlled trial. Setting: Six urban regions in New York State. Participants: 417 neurologists. Intervention: The educational strategy promoted six recommendations for eva luation and management of dementia. It included a mailed American Academy o f Neurology continuing medical education course, practice-based tools, an i nteractive evidence-based American Academy of Neurology-sponsored seminar l ed by local opinion leaders, and follow-up mailings. Measurements: Neurologists' adherence to guidelines was measured by using d etailed clinical scenarios mailed to a baseline group 3 months before the i ntervention and to intervention and control groups 6 months after the inter vention. In one region, patients' medical records were reviewed to determin e concordance between neurologists' scenario responses and their actual car e. Results: Compared with neurologists in the baseline and control groups, neu rologists in the intervention group were more adherent to three of the six recommendations: neuroimaging for patients with dementia only when certain criteria are present (odds ratio, 4.1 [95% CI, 1.9 to 8.9]), referral of al l patients with dementia and their families to the Alzheimer's Association (odds ratio, 2.8 [CI, 1.7 to 4.8]), and encouragement of all patients and t heir families to enroll in the Alzheimer's Association Safe Return Program (odds ratio, 10.8 [CI, 3.5 to 33.2]). For the other three recommendations, adherence did not differ between the intervention and the nonintervention g roups. Agreement between scenario responses and actual care ranged from 27% to 99% for the six recommendations and was 95% or more for three of the re commendations. Conclusion: A multifaceted educational program can improve physician adopti on of practice guidelines.