Q J Med 2004; 97: 21-31
© Association of Physicians 2004; all rights reserved.
Drug treatment of stable angina pectoris and mass dissemination of therapeutic guidelines: a randomized controlled trial
From the 1Chaire docteur Sadok Besrour en médecine familiale, Centre de recherche du Centre Hospitalier de l’Université de Montréal, 2Divisions of Cardiology and Clinical Epidemiology, McGill University Health Centre, 3Collège des médecins du Québec, 4Département d’administration de la santé, Université de Montréal, and 5Agence d’évaluation des technologies et des modes d’intervention en santé, Montreal, Quebec, Canada
Received 8 August 2003 and in revised form 21 October 2003
Background: Public agencies responsible for implementing health care policies often adapt and disseminate clinical practice guidelines, but the effectiveness of mass dissemination of guidelines is unknown.
Aim: To study the effects of guideline dissemination on physicians’ prescribing practices for the treatment of stable angina pectoris.
Design: Randomized controlled trial.
Methods: A sample of 3293 Quebec physicians were randomly assigned to receive a one-page summary of clinical practice guidelines on the treatment of stable angina (in February 1999), to receive the summary and a reminder (in February and March 1999, respectively), or to receive no intervention (controls). The prescribing profiles of participants, as well as sociodemographic characteristics of the physicians and their patients, were examined for June–December 1999.
Results: The intervention had no effect on prescription rates of ß-blockers, antiplatelet agents, or hypolipaemic drugs. Compared to 1997 data for the same physicians, there was an overall 10% increase in appropriate prescription rates, irrespective of the intervention.
Discussion: In-house production and dissemination of clinical practice guidelines may not improve physicians’ practice patterns if there is pre-existing substantial scientific consensus on the issue.
Address correspondence to Dr M.-D. Beaulieu, Centre de recherche du CHUM, Hôpital Notre-Dame, Pavillon L.-C. Simard, 8e étage1560, rue Sherbrooke EstMontréal (Québec) H2L 4M1, Canada. e-mail: maried.beaulieu{at}sympatico.ca
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