Synergy between publication and promotion: Comparing adoption of new evidence in Canada and the United States
Synergy between publication and promotion: Comparing adoption of new evidence in Canada and the United States
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DOI：
10.1016/s0002-9343(03)00422-4
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发表时间：
2003-10-15
影响因子：
5.9
通讯作者：
Soumerai, SB
中科院分区：
文献类型：
--
作者：
Majumdar, SR;McAlister, FA;Soumerai, SB
目的：很少有研究检验临床试验新证据对医师实践的影响。我们利用加拿大和美国心脏结局预防和评估（HOPE）研究和随机醛内酯评估研究（RALES）的宣传活动差异来确定新证据的发表是否会改变实践，以及宣传在多大程度上影响新证据的采用。方法：我们使用从1998年到2001年收集的纵向分配数据，来检查在HOPE研究前后雷米普利和其他血管紧张素转换酶（ACE）抑制剂处方模式的变化。我们还获得了促销支出的估计。我们按国家进行分层分析，以隔离促销的影响，并使用中断时间序列方法来调整预先存在的处方趋势。对RALES前后使用螺内酯进行了类似的分析。结果：HOPE研究结果的发表与雷米普利使用的迅速增加有关。在对已有处方趋势进行调整后，在研究结果发表后，加拿大的雷米普利处方每月增加12% (P = 0.001)，而美国每月增加5% （P = 0.001）。一年后，雷米普利占加拿大ACE抑制剂市场的30%，而在美国占6%。在公布这些结果的前一年，加拿大的详细医疗支出增加了20%（达到每位医生18美元），而美国则下降了7%（降至每位医生13美元）；出版后的一年，加拿大每位医生的支出增加到27美元，而美国为23美元。在两国均未开展RALES宣传活动的情况下，研究结果的公布与两国螺内酯使用量每月2%的较为温和但相似的增长（P < 0.001）相关。结论：新证据的发表与实践中的适度改变有关。宣传活动似乎增加了证据的采纳。那些希望加速采用新证据的人可能需要进行更积极的宣传，而不是依靠发表文章和制定指南。(C) 2003年由摘录医疗公司。
PURPOSE: Few studies have examined the effect of new evidence from clinical trials on physician practice. We took advantage of differences in promotional activity in Canada and the United States for the Heart Outcomes Prevention and Evaluation (HOPE) study and the Randomized Aldactone Evaluation Study (RALES) to determine if publication of new evidence changes practice, and the extent to which promotion influences adoption of new evidence.METHODS: We used longitudinal dispensing data, collected from 1998 to 200 1, to examine changes in prescribing patterns for ramipril and other angiotensin-converting enzyme (ACE) inhibitors before and after the HOPE study. We also obtained estimates for promotional expenditures. We stratified analyses by country, to isolate the effect of promotion, and used interrupted time series methods to adjust for pre-existing prescribing trends. Similar analyses were conducted for spironolactone use before and after RALES.RESULTS: Publication of the HOPE study results was associated with rapid increases in the use of ramipril. After adjusting for pre-existing prescribing trends, ramipril prescribing in-creased by 12% per month (P = 0.001) in Canada versus 5% per month (P = 0.001) in the United States after the study results were presented and published. One year later, ramipril accounted for 30% of the ACE inhibitor market in Canada versus 6% in the United States. The year before publication of these results, expenditures for detailing increased by 20% in Canada (to $18 per physician) but decreased by 7% in the United States (to $13 per physician); the year after publication, spending increased to $27 per physician in Canada versus $23 per physician in the United States. in the absence of promotional activity for RALES in either country, publication of results was associated with more modest but similar increases of 2% per month (P 0.001) in spironolactone use in both countries.CONCLUSION: Publication of new evidence is associated with modest changes in practice. Promotional activity appears to increase the adoption of evidence. Rather than relying on the publication of articles and creation of guidelines, those wishing to accelerate the adoption of new evidence may need to undertake more active promotion. (C) 2003 by Excerpta Medica Inc.