One-to-one versus group sessions to improve prescription in primary care -A pragmatic randomized controlled trial

OBJECTIVES. The objective of the study was to evaluate the effectiveness of 2 educational strategies aimed at improving prescribing standards in prima ry care. METHODS. A pragmatic controlled trial was designed; the study population in cluded general and family practitioners in Galicia (northwestern Spain) div ided into 3 study groups: a one-to-one education group (n = 98), a by-group education group (n = 92), and a control group (n = 405). The educational i ntervention included explicit recommendations for selecting nonsteroidal an ti-inflammatory drugs (NSAIDs) for inflammation signs. Some of the subjects were given reminders. Mixed-effect linear models were applied to data anal ysis. Analyses were done by intention-to-treat. The dependent variable is a rate with a numerator that is the number of prescribed units of the NSAIDs recommended during intervention; the denominator is the total number of pr escribed units of the NSAID total. RESULTS. One-to-One education obtained an average prescribing behavior impr ovement of 6.5% (P <0.001) in the 9 months after intervention. In the educa tion group, the average improvement was 2.4% (P <0.05) for the same period. Statistically significant differences were observed between the group inte rvention and one-to-one groups. The reminder increased significantly the ef fectiveness of the one-to-one intervention. CONCLUSIONS. A single, short educational session to primary care doctors ca n improve their prescribing standards during long periods of greater than o r equal to9 months. Of the 2 strategies followed in the trial, one-to-one e ducation has shown to be the most effective. Results also show that the eff ectiveness of these interventions increases when presented together with wr itten material.