An Educational Experiment in Primary Care in Sweden

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Abstract
Objectives: An educational experiment was conducted in Swedish primary care to evaluate the effects of noncommercial treatment information based on national guidelines on the management of hypercholesterolemia. Methods: Community health centres (n=134), with 570 doctors, were randomly allocated to an intervention or a control group. The information was conveyed by community pharmacists and discussed during four group sessions. Clinical performance was studied after the intervention through a retrospective review of 2883 medical records for patients aged 30-65 years with hypercholesterolemia (≥6.5 mmol/1) at each of 110 consenting health centres. Diagnostic investigations, and non-pharmacological and drug treatment actions were used as outcome measures. Results: For patients with more than one other risk factor for coronary heart disease (CHD) and severe hypercholesterolemia (>7.8 mmol/1), the prescription rate of a lipid-lowering drug was 17% higher in the intervention group compared with the control group (p<0.01), which was mainly due to a significantly higher prescribing to women (p<0.001). Similarly, for patients with moderate hypercholesterolemia (6.5-7.8 mmol/1) and a history of CHD, the prescription rate was 11% higher in the intervention group (p<0.01). Significant differences were also found for diagnostic investigations and information on diet modification. Conclusions: The findings indicate that group education with primary care doctors in the form of ‘academic detailing’ by pharmacists can improve doctors’ clinical performance in line with treatment guidelines.