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MANAGED CARE

Effect of an Academic Detailing Intervention on the Utilization Rate of Cyclooxygenase-2 Inhibitors in the Elderly

Lecturer, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

Abraham G Hartzema, PharmD MSPH PhD FISPE

Professor and Eminent Scholar, Perry A Foote Chair in Health Outcomes Research, College of Pharmacy, University of Florida, Gainesville, FL

Ingrid S Sketris, PharmD MPA (HSA)

Professor, College of Pharmacy, Dalhousie University, Canadian Health Services Research Foundation/Canadian Institutes of Health Research/Nova Scotia Health Research Foundation Chair in Drug Use Management and Policy Research

Almut G Winterstein, PhD

Assistant Professor, College of Pharmacy, University of Florida

Reprints: Reprints available from The Annals upon request.

BACKGROUND: Osteoarthritis is prevalent in the elderly. Nova Scotia general practitioners (GPs) identified the need for an academic detailing (AD) intervention aimed at optimizing the management of osteoarthritis. AD was provided by Dalhousie University Continuing Medical Education in a face-to-face encounter employing evidence-based information. GP participation was voluntary.

OBJECTIVE: To evaluate the effect of a GP-targeted osteoarthritis AD intervention on a reduction in the prescribing of cyclooxygenase-2 (COX-2) inhibitors, as well as examine the intervention effect on the utilization rates of gastroprotective agents and medical services.

METHODS: A retrospective cohort study design employing administrative data was used. Differences in utilization rates between intervention and control groups were evaluated using generalized estimating equations analysis for longitudinal data over four 90-day postintervention periods. Confounding was addressed using propensity scores to adjust for between-group bias on the measured covariates.

RESULTS: The between-group difference for change in COX-2 utilization rates was 0.76 defined daily doses/patient (p = 0.040; 95% CI 0.037 to 1.48) for the 3-month period following the intervention, with lower COX-2 utilization in the AD intervention group than in the control group. The intervention group showed a significant decrease in the within-group utilization rate between the pre- and postintervention periods (z =–2.34; p = 0.019). The between-group difference for change in GP office visit rates was 0.40 visits/patient (p = 0.028; 95% CI 0.046 to 0.79) with the intervention group, showing higher visit rates compared with the control group.

CONCLUSIONS: The osteoarthritis AD intervention was associated with a significant decrease (23%) in COX-2 utilization rates in the 3-month period immediately following the intervention. The only secondary outcome to show a significant between-group effect was the GP office visit rate, which was higher for the intervention group in the second 3-month postintervention period.

Key Words: academic detailing, cyclooxygenase-2 inhibitors, pharmacoepidemiology, prescribing behavior

Published Online, April 22, 2008. www.theannals.com, DOI 10.1345/aph.1K537