Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: An Open Cluster-randomized, 18 Month Trial to Compare the Effectiveness of Educational Outreach Visits With Usual Guideline Dissemination to Improve Family Physician Prescribing
Brief Summary: Background: The Portuguese National Health Directorate has issued clinical practice guidelines on prescription of anti-inflammatory drugs and COX-2 inhibitors, acid suppressive therapy and proton pump inhibitors, and anti-platelets. However, their effectiveness in changing actual practice is unknown. The objectives will be to compare the effectiveness of educational outreach visits in the implementation of clinical guidelines in primary care in Portugal against usual implementation strategies and to conduct a cost-effectiveness analysis of this method.

Methods: The trial will be a parallel, cluster-randomized, unblinded, trial in primary care, with a 1:1 allocation ratio. This study will assess the effect of educational outreach visits on physician compliance with prescription guidelines. The general study hypothesis is whether educational outreach visits are superior to usual implementation of guidelines regarding the reduction of inappropriate prescribing (compliance with prescription guidelines). All National Health Service primary care units in the Lisbon (Portugal) region will be invited to participate. Units will be eligible if they are using an Electronic Health Record to issue prescriptions and have at least four doctors willing to participate. Doctors in intervention units will receive three educational outreach visits (one for each guideline) during a six months period, while the control group doctors will be offered an unrelated group training session (on using the international classification for primary care). Intervention visits will be one on one 15 minutes discussions conducted by guideline authors or trained family physicians at the physician's workplace. There are two primary outcomes, measured at the physician's level. One is the proportion of COX-2 inhibitors prescribed within the entire NSAID class, in defined daily doses 18 months after the intervention. The other is the proportion of omeprazole within the entire proton pump inhibitors class, in defined daily doses at 18 months post-intervention. Prescription data will be collected from the regional pharmacy claims database.


Options:
A: Arm Label: SSL Implementation Strategy; Type: EXPERIMENTAL; Interventions: Other: SSL Implementation Strategy | Arm Label: Standard Care; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: OTHER; Name: SSL Implementation Strategy; Assigned to Arm(s): SSL Implementation Strategy
B: Arm Label: MJAP Clinics Intervention; Type: EXPERIMENTAL; Interventions: Behavioral: START | Arm Label: MJAP Clinics Pre-Intervention; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: BEHAVIORAL; Name: START; Assigned to Arm(s): MJAP Clinics Intervention
C: Arm Label: Educational Outreach Visits; Type: EXPERIMENTAL; Interventions: Behavioral: Educational Outreach Visits | Arm Label: Passive Dissemination; Type: ACTIVE_COMPARATOR; Interventions: Other: Passive Dissemination | Intervention Type: BEHAVIORAL; Name: Educational Outreach Visits; Assigned to Arm(s): Educational Outreach Visits | Intervention Type: OTHER; Name: Passive Dissemination; Assigned to Arm(s): Passive Dissemination
D: Intervention Type: BEHAVIORAL; Name: Evidence summaries endorsed by local opinion leaders; Assigned to Arm(s): N/A

Answer: C