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G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

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Effect of a single continuing medical education (CME) report on prescription behaviour. Results from the disease management programme (DMP) coronary artery disease (CAD) in the North Rhine region, Germany

Meeting Abstract

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  • B. Hagen - Central Research Institute for Ambulatory Health Care in Germany, Cologne, Germany
  • I. Schwang - St. Marien-Hospital, Department of Cardiology, Hamm, Germany
  • L. Altenhofen - Central Research Institute for Ambulatory Health Care in Germany, Cologne, Germany
  • R. Griebenow - Cologne-Merheim Hospital, Department of Cardiology, Cologne, Germany
  • J. Kretschmann - Central Research Institute for Ambulatory Health Care in Germany, Cologne, Germany
  • A. Weber - Central Research Institute for Ambulatory Health Care in Germany, Cologne, Germany

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP168

doi: 10.3205/12gin280, urn:nbn:de:0183-12gin2805

Published: July 10, 2012

© 2012 Hagen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Background: In 2005 29.3% of the patients with heart failure (NYHA class 2–3) in the DMP CAD received a calcium antagonist (CAA), which is not part of the guideline recommended first line therapy (beta blockers BB plus ACE inhibitors ACE-I).

Objective: Can a single CME report on use of CAA in patients with heart failure added to the regular feedback report increase the prescription rate for guideline recommended therapy?

Results: Change of prescriptions of CAA, BB and ACE-I, and time course of blood pressure were analyzed in CAD patients with heart failure. In 2005 428 of 3,495 physicians (12%) answered the CME questionnaire. They took care of 955 patients with heart failure (NYHA 2–3), of whom follow-up documentation was available until 2008 (5,092 patients of physicians who did not answer CME). CAA prescription changed from 28.1–27.6% (29.9–31.2), BB from 78.9–80.5% (74.6–78.1), ACE-I from 69.9–74.6% (72.8–73.6), and BB+ACE-I from 53–59.5% (54.8–58.2), p for group differences .02–.59. Systolic blood pressure decreased from 129.1–128.5 mmHg, p = .43 (131.7–129.9, p < .001).

Discussion: Difference over time in prescription rates for guideline compliant medications was consistent in favour of those physicians who had participated in the CME activity. The latter did not influence prescription of heart failure medications, which showed a slow and modest increase over time (3 y) in the total group.

Implications: Guideline knowledge is high, but for improvement of prescription behaviour other factors than just updating knowledge also have to be addressed.