Education effort increased thiazide use
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An effort to disseminate evidence-based information on thiazide-type diuretics resulted in a small increase in the use of the medications, a new study found.
Between 2004 and 2007, more than 100 investigator-educators met with more than 18,000 physicians in different parts of the country to educate them about the results of ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), which supported the use of thiazides as first-line therapy for hypertension. This study compared use of the drugs in counties where the investigator-educators had been active with use in areas where they hadn't. The results were published in the May 24 Archives of Internal Medicine.
According to a survey of physicians, the percentage of hypertension visits in which the drugs were recorded went up the most in areas where the educators were most active: an increase of 8.6% in active counties compared to 2% or lower increases in other areas. Pharmacy dispensing data showed a similar trend. Thiazide prescriptions went up 8.7% in active counties compared to 3.9% in inactive ones.
Study authors noted that the effect of the program was small, but consistent with the small dose of the intervention that physicians received. In addition, the project had to compete with public questioning of the ALLHAT findings by the pharmaceutical industry and others. Still, they concluded that such efforts, which they described as academic detailing, have the potential to improve prescribing patterns.
Although he praised the effort in an accompanying commentary, Jerry Avorn, MD, noted that it was not actually academic detailing, a concept which he invented. Academic detailing typically involves a one-to-one encounter like that of a pharmaceutical rep visiting a physician, while the ALLHAT dissemination program used group presentations. The difference was probably a major contributor to the project's small effect, Dr. Avorn noted. More work is needed on how to develop delivery systems for getting evidence-based data into clinical practice, he concluded.