Ontario Printed Educational Materials (PEMs) for Physician Behaviour Change

Study Overview
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Brief Summary
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The purpose of this study is to determine whether printed educational materials can change physician behaviour towards more evidence based decision-making.

Detailed Description
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BACKGROUND: There are gaps between what family practitioners do in clinical practice and the evidence-based ideal. The most commonly used strategy to narrow these gaps is the printed educational message (PEM); however, the attributes of successful printed educational messages and their overall effectiveness in changing physician practice are not clear. The current endeavor aims to determine whether such messages change prescribing quality in primary care practice, and whether these effects differ with the format of the message. METHODS/DESIGN: The design is a large, simple, factorial, unblinded cluster-randomized controlled trial. PEMs will be distributed with informed, a quarterly evidence-based synopsis of current clinical information produced by the Institute for Clinical Evaluative Sciences, Toronto, Canada, and will be sent to all eligible general and family practitioners in Ontario. There will be three replicates of the trial, with three different educational messages, each aimed at narrowing a specific evidence-practice gap as follows: 1) angiotensin-converting enzyme inhibitors, hypertension treatment, and cholesterol lowering agents for diabetes; 2) retinal screening for diabetes; and 3) diuretics for hypertension.For each of the three replicates there will be three intervention groups. The first group will receive informed with an attached postcard-sized, short, directive outsert. The second intervention group will receive informed with a two-page explanatory insert on the same topic. The third intervention group will receive informed, with both the above-mentioned outsert and insert. The control group will receive informed only, without either an outsert or insert.Routinely collected physician billing, prescription, and hospital data found in Ontario's administrative databases will be used to monitor pre-defined prescribing changes relevant and specific to each replicate, following delivery of the educational messages. Multi-level modeling will be used to study patterns in physician-prescribing quality over four quarters, before and after each of the three interventions. Subgroup analyses will be performed to assess the association between the characteristics of the physician's place of practice and target behaviours.A further analysis of the immediate and delayed impacts of the PEMs will be performed using time-series analysis and interventional, auto-regressive, integrated moving average modeling.

Official Title
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The Ontario Printed Educational Message (OPEM) Trial to Narrow the Evidence-practice Gap With Respect to Prescribing Practices of General and Family Physicians: a Cluster Randomized Controlled Trial

Conditions
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Education, Medical, Continuing, Practice Patterns, Hypertension, Diabetes Mellitus, Type 2

Intervention / Treatment
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* Behavioral: Printed Educational Message


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Family physicians or general practitioners in Ontario with >100 patients over 65 years of age in fee for service practice with >$50,000 billings to Ontario Health Insurance Plan (OHIP) in 2003 Exclusion Criteria: Physicians who have elected not to receive informed. informed is a quarterly newsletter on evidence based practice produced by the Institute for Clinical Evaluative Sciences (ICES) and is the vehicle for delivery of the printed educational messages.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>Usual practice; no additional information provided. | |
| Experimental: Printed Educational Message #1<br>Information about Angiotensin-converting enzyme inhibitors, hypertension treatment, and cholesterol lowering agents for diabetes | Behavioral: Printed Educational Message<br>* Three forms of printed educational materials (short or long educational messages and patient reminder notes)<br>|
| Experimental: Printed Educational Message #2<br>Retinal screening for diabetes | Behavioral: Printed Educational Message<br>* Three forms of printed educational materials (short or long educational messages and patient reminder notes)<br>|
| Experimental: Printed Educational Message #3<br>Diuretics for hypertension | Behavioral: Printed Educational Message<br>* Three forms of printed educational materials (short or long educational messages and patient reminder notes)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Behavioral intention related to referring patient for retinopathy screening |  | Two months and six months post intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Attitude (Theory of Planned Behaviour) |  | Two months and six months post intervention | 
| Change in Subjective Norm (Theory of Planned Behaviour) |  | Two months and six months post intervention | 
| Change in Perceived Behavourial Control (Theory of Planned Behaviour) |  | Two months and six months |