Evaluation of academic detailing visits on GP knowledge and practice for statin use and management
Isla Hains A B , Natalie Raffoul A and Jeannie Yoo A
+ Author Affiliations
- Author Affiliations
A NPS MedicineWise, PO Box 1147, Strawberry Hills, NSW 2012, Australia.
B Corresponding author. Email: ihains@nps.org.au
Australian Journal of Primary Health 26(6) 492-499 https://doi.org/10.1071/PY20062
Submitted: 19 March 2020 Accepted: 14 August 2020 Published: 2 October 2020
Abstract
Dyslipidaemia is a major risk factor for cardiovascular disease (CVD) and is routinely managed by GPs. Lipid-modifying medicines, commonly statins, are used to treat dyslipidaemia and prevent CVD in high-risk individuals. A national education program for over 8000 Australian GPs was delivered and evaluated. The program aimed to optimise the use of statins and provide GPs with an Australian-developed statin-associated muscle symptoms (SAMS) management algorithm supporting assessment and management of suspected SAMS. Retrospective pre-test and control questionnaires were administered to measure changes in knowledge and intended practice following the education program. A total of 226 participant GPs and 150 control GPs completed the questionnaires. The program led to positive changes in GP knowledge and intended practice around the use of absolute CVD risk to make prescribing decisions. Participant GPs demonstrated increased knowledge, compared with control GPs, about the use of CVD risk calculators as the most effective approach to lipid management, and adequately trialling a statin before considering a second agent. One of the greatest improvements in participant GP-intended practice related to the assessment and management of suspected SAMS, with participant GPs more likely to appropriately identify and manage suspected SAMS than control GPs.
Keywords: evidence-based practice, health behaviour, health education, physicians’ practice patterns, primary health care.
References
Allen JM, Nimon K (2007) Retrospective pretest: a practical technique for professional development evaluation. Journal of Industrial Teacher Education 44, 27–42.Australian Government Department of Health (2019) Department of Health GP workforce statistics 2017–18. (Australian Government Department of Health: Canberra, ACT, Australia) Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/General+Practice+Statistics-1 [Verified December 2019]
Australian Institute of Health and Welfare (2015) Cardiovascular disease, diabetes and chronic kidney disease – Australian facts: risk factors. Cardiovascular, diabetes and chronic kidney disease series no. 4. Cat. no. CDK 4. (AIHW: Canberra, ACT, Australia) Available at https://www.aihw.gov.au/reports/heart-stroke-vascular-disease/cardiovascular-diabetes-chronic-kidney-risk-factor/contents/table-of-contents [Verified 17 September 2020]
Australian Medicines Handbook Pty Ltd (2019) ‘Australian Medicines Handbook 2019.’ (Australian Medicines Handbook Pty Ltd: Adelaide, SA, Australia) Available at https://amhonline.amh.net.au/chapters/cardiovascular-drugs/drugs-dyslipidaemia/statins?menu=hints [Verified 16 July 2019]
Banks E, Crouch SR, Korda RJ, Stavreski B, Page K, Thurber KA, Grenfell R (2016) Absolute risk of cardiovascular disease events, and blood pressure- and lipid-lowering therapy in Australia. The Medical Journal of Australia 204, 320
| Absolute risk of cardiovascular disease events, and blood pressure- and lipid-lowering therapy in Australia.Crossref | GoogleScholarGoogle Scholar | 27125809PubMed |
Bhanji F, Gottesman R, de Grave W, Steinert Y, Winer LR (2012) The retrospective pre–post: a practical method to evaluate learning from an educational program. Academic Emergency Medicine 19, 189–194.
| The retrospective pre–post: a practical method to evaluate learning from an educational program.Crossref | GoogleScholarGoogle Scholar | 22320369PubMed |
Britt H, Miller G, Henderson J, Bayram C, Harrison C, Valenti L, Wong C, Gordon J, Pollack A, Pan Y, Charles J (2015) General practice activity in Australia 2014–15. (Sydney University Press: Sydney, NSW, Australia) Available at purl.library.usyd.edu.au/sup/9781743324523 [Verified 16 December 2015]
Cannon CP, Steinberg BA, Murphy SA, Mega JL, Braunwald E (2006) Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy. Journal of the American College of Cardiology 48, 438–445.
| Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy.Crossref | GoogleScholarGoogle Scholar | 16875966PubMed |
Cardiovascular Therapeutic Guidelines (2019) Lipid modification [revised 2018 Mar]. In ‘eTG complete’. (Therapeutic Guidelines Limited: Melbourne, Vic., Australia)
Choosing Wisely Australia (2015) The Royal Australian College of General Practitioners: tests, treatments and procedures clinicians and consumers should question. (Choosing Wisely Australia: Sydney, NSW, Australia) Available at http://www.choosingwisely.org.au/recommendations/racgp [Verified 13 December 2019]
Chowdhury R, Khan H, Heydon E, Shroufi A, Fahimi S, Moore C, Stricker B, Mendis S, Hofman A, Mant J, Franco OH (2013) Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. European Heart Journal 34, 2940–2948.
| Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences.Crossref | GoogleScholarGoogle Scholar | 23907142PubMed |
Cohen JD, Brinton EA, Ito MK, Jacobson TA (2012) Understanding Statin Use in America and Gaps in Patient Education (USAGE): an internet-based survey of 10,138 current and former statin users. Journal of Clinical Lipidology 6, 208–215.
| Understanding Statin Use in America and Gaps in Patient Education (USAGE): an internet-based survey of 10,138 current and former statin users.Crossref | GoogleScholarGoogle Scholar | 22658145PubMed |
Colquhoun D (2008) How to treat hypercholesterolaemia. Australian Prescriber 31, 119–122.
| How to treat hypercholesterolaemia.Crossref | GoogleScholarGoogle Scholar |
Dyrkorn R, Langaas HC, Giverhaug T, Espnes KA, Rowett D, Spigset O (2019) Academic detailing as a method of continuing medical education. Advances in Medical Education and Practice 10, 717–725.
| Academic detailing as a method of continuing medical education.Crossref | GoogleScholarGoogle Scholar | 31507335PubMed |
Gupta R, Stocks N, Broadbent J (2009) Cardiovascular risk assessment in Australian general practice. Australian Family Physician 38, 364–368.
Heeley EL, Peiris DP, Patel AA, Cass A, Weekes A, Morgan C, Anderson CS, Chalmers JP (2010) Cardiovascular risk perception and evidence–practice gaps in Australian general practice (the AusHEART study). The Medical Journal of Australia 192, 254–259.
| Cardiovascular risk perception and evidence–practice gaps in Australian general practice (the AusHEART study).Crossref | GoogleScholarGoogle Scholar | 20201758PubMed |
Hill LG, Betz DL (2005) Revisiting the retrospective pretest. The American Journal of Evaluation 26, 501–517.
| Revisiting the retrospective pretest.Crossref | GoogleScholarGoogle Scholar |
Lam TC, Bengo P (2003) A comparison of three retrospective self-reporting methods of measuring change in instructional practice. The American Journal of Evaluation 24, 65–80.
| A comparison of three retrospective self-reporting methods of measuring change in instructional practice.Crossref | GoogleScholarGoogle Scholar |
Manuel DG, Lim J, Tanuseputro P, Anderson GM, Alter DA, Laupacis A, Mustard CA (2006) Revisiting Rose: strategies for reducing coronary heart disease. BMJ (Clinical Research Ed.) 332, 659–662.
| Revisiting Rose: strategies for reducing coronary heart disease.Crossref | GoogleScholarGoogle Scholar |
National Vascular Disease Prevention Alliance (2012) Guidelines for the management of absolute cardiovascular disease risk. Available at https://informme.org.au/Guidelines/Guidelines-for-the-assessment-and-management-of-absolute-CVD-risk [Verified 17 September 2020]
Nimon K, Zigarmi D, Allen J (2011) Measures of program effectiveness based on retrospective pretest data: are all created equal? The American Journal of Evaluation 32, 8–28.
| Measures of program effectiveness based on retrospective pretest data: are all created equal?Crossref | GoogleScholarGoogle Scholar |
NPS MedicineWise (2020) MedicineInsight. (NPS MedicineWise: Sydney, NSW, Australia) Available at https://www.nps.org.au/medicine-insight [Verified 3 July 2020]
O’Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, Forsetlund L, Bainbridge D, Freemantle N, Davis D (2007) Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2007, CD000409
| Educational outreach visits: effects on professional practice and health care outcomes.Crossref | GoogleScholarGoogle Scholar |
Parkinson A, Jorm L, Douglas KA, Gee A, Sargent GM, Lujic S, McRae IS (2015) Recruiting general practitioners for surveys: reflections on the difficulties and some lessons learned. Australian Journal of Primary Health 21, 254–258.
| Recruiting general practitioners for surveys: reflections on the difficulties and some lessons learned.Crossref | GoogleScholarGoogle Scholar | 24581281PubMed |
Pratt CC, McGuigan WM, Katzev AR (2000) Measuring program outcomes: using retrospective pretest methodology. The American Journal of Evaluation 21, 341–349.
| Measuring program outcomes: using retrospective pretest methodology.Crossref | GoogleScholarGoogle Scholar |
Raffoul N (2019) CVD risk assessment in Australian primary care. In ‘GP19’, 25 October 2019, Adelaide, SA, Australia. (RACGP: Melbourne, Vic., Australia)
Rodriguez F, Maron DJ, Knowles JW, Virani SS, Lin S, Heidenreich PA (2017) Association between intensity of statin therapy and mortality in patients with atherosclerotic cardiovascular disease. JAMA Cardiology 2, 47–54.
| Association between intensity of statin therapy and mortality in patients with atherosclerotic cardiovascular disease.Crossref | GoogleScholarGoogle Scholar | 27829091PubMed |
Silva MA, Swanson AC, Gandhi PJ, Tataronis GR (2006) Statin-related adverse events: a meta-analysis. Clinical Therapeutics 28, 26–35.
| Statin-related adverse events: a meta-analysis.Crossref | GoogleScholarGoogle Scholar | 16490577PubMed |
Soumerai SB, Avorn J (1990) Principles of educational outreach (‘academic detailing’) to improve clinical decision making. Journal of the American Medical Association 263, 549–556.
| Principles of educational outreach (‘academic detailing’) to improve clinical decision making.Crossref | GoogleScholarGoogle Scholar | 2104640PubMed |
Stroes ES, Thompson PD, Corsini A, Vladutiu GD, Raal FJ, Ray KK, Roden M, Stein E, Tokgözoğlu L, Nordestgaard BG, Bruckert E, De Backer G, Krauss RM, Laufs U, Santos RD, Hegele RA, Hovingh GK, Leiter LA, Mach F, März W, Newman CB, Wiklund O, Jacobson TA, Catapano AL, Chapman MJ, Ginsberg HN, European Atherosclerosis Society Consensus Panel (2015) Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. European Heart Journal 36, 1012–1022.
| Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management.Crossref | GoogleScholarGoogle Scholar | 25694464PubMed |
Turin A, Pandit J, Stone NJ (2015) Statins and nonadherence: should we RELATE better? Journal of Cardiovascular Pharmacology and Therapeutics 20, 447–456.
| Statins and nonadherence: should we RELATE better?Crossref | GoogleScholarGoogle Scholar | 25827856PubMed |
Webster RJ, Heeley EL, Peiris DP, Bayram C, Cass A, Patel AA (2009) Gaps in cardiovascular disease risk management in Australian general practice. The Medical Journal of Australia 191, 324–329.
| Gaps in cardiovascular disease risk management in Australian general practice.Crossref | GoogleScholarGoogle Scholar | 19769555PubMed |
