A Randomized Trial of a Program to Reduce the Use of Psychoactive Drugs in Nursing Homes

Avorn, Jerry; Soumerai, Stephen B.; Everitt, Daniel E.; Ross‐Degnan, Dennis; Beers, Mark H.; Sherman, David S.; Salem‐Schatz, Susanne; Fields, David R.

doi:10.1056/nejm199207163270306

Cited by 348 publications

(271 citation statements)

References 21 publications

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“…Promising results have been achieved in randomized trials of "academic detailing" (2,83,89). The principles of this method (91) include understanding clinician behavior; use of succinct, high-quality graphical materials; sponsorship by authoritative and credible organizations; and presentation and discussion of barriers and counterarguments (3,6,83). More recently, controlled trials have noted success with expanding from individual to small-group sessions (47,101).…”

Section: The Chronic Care Modelmentioning

confidence: 99%

How Can We Increase Translation of Research into Practice? Types of Evidence Needed

Glasgow

Emmons

2007

Annu. Rev. Public Health

840

758

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This review summarizes key factors that have interfered with translation of research to practice and what public health researchers can do to hasten such transfer, focusing on characteristics of interventions, target settings, and research designs. The need to address context and to utilize research, review, and reporting practices that address external validity issues-such as designs that focus on replication, and practical clinical and behavioral trials-are emphasized.Although there has been increased emphasis on social-ecological interventions that go beyond the individual level, interventions often address each component as if it were an independent intervention. Greater attention is needed to connectedness across program levels and components. Finally, examples are provided of evaluation models and current programs that can help accelerate translation of research to practice and policy.

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Section: The Chronic Care Modelmentioning

confidence: 99%

How Can We Increase Translation of Research into Practice? Types of Evidence Needed

Glasgow

Emmons

2007

Annu. Rev. Public Health

840

758

View full text Add to dashboard Cite

show abstract

“…55,56 More recent studies have analyzed academic detailing in a wide variety of settings. A 2007 Cochrane review analyzed sixtynine trials of such educational outreach, involving more than 15,000 health professionals.…”

Section: Some Possible Solutionsmentioning

confidence: 99%

‘Bench To Behavior’: Translating Comparative Effectiveness Research Into Improved Clinical Practice

Avorn

Fischer

2010

Health Affairs

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The new national emphasis on comparative effectiveness research is likely to generate an unprecedented volume of new findings. It is essential to anticipate the obstacles that front-line health care professionals will face in translating these results into better clinical decision making. We review the current barriers to the dissemination of evidence-based clinical recommendations, including problems with continuing medical education, provider incentives, and quality assurance. We then propose solutions, including more effective educational outreach programs, requirements for practitioners to master important findings, and alignment of incentives to encourage evidence-based practice. Such strategies can lead to policies that could encourage the uptake of new comparative effectiveness data and encourage their translation into better clinical practice.T he industrialized world has focused intensely in recent decades on applying advances in basic biomedical research to the production of new drugs and devices. However, this "bench to bedside" translation has not been matched by comparable attention to using that research to change what physicians actually dowhat might be called the "bench to behavior" translation. A major gap persists between the best available information on therapeutic effectiveness and safety, on the one hand, and typical patterns of care, on the other.1,2 Problems in translating into practice the conclusions of several major comparative effectiveness research trials, as discussed below, show that studies may be rigorously designed and carried out, producing important clinical findings, yet remain poorly applied in typical practice settings. Emergence Of New Research FindingsAs a result of recent changes in federal law, new funding, and the creation of the new PatientCentered Outcomes Research Institute, the United States is now gearing up to produce an unprecedented volume of new research evaluating comparable therapeutic interventions. It is critical to understand the barriers that exist between generating these comparative effectiveness findings and changing practice by front-line physicians and other health professionals-and to develop strategies to overcome these obstacles. 3Delaying the adoption of research findingsor refusing to adopt them-is not a novel problem in medicine. In the mid-nineteenth century, Ignác Semmelweis in Europe and Oliver Wendell Holmes Sr. in the United States employed observational and then interventional "comparative effectiveness" studies to demonstrate that hand washing by health professionals before they delivered babies was associated with a marked reduction in maternal death from puerperal fever, a serious bacterial infection that can affect mothers after childbirth. Yet it took the medical profession years to incorporate these life-saving

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“…in the 1980s. 41,42 In this approach, medical school faculty working through a nonprofit organization with no ties to any pharmaceutical company perform a rigorous review of the evidence on optimal management of a given clinical topic (eg, hypercholesterolemia, or the evidence-based use of antiplatelet agents). That organization then condenses these syntheses into user-friendly, clinically relevant summaries of evidencebased recommendations.…”

Section: Options For the Alternative Funding Of Cmementioning

confidence: 99%

Funding for Medical Education: Maintaining a Healthy Separation From Industry

Avorn

Choudhry

2010

Circulation

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The term profession is applied to those persons who have specialized and technical skill or knowledge which they apply, for a fee, to certain tasks that ordinary and unqualified people cannot ordinarily undertake. The term derives from the Latin: "to swear (an oath) …".-Wikipedia 2 L et's consider how we as cardiovascular medicine specialists spend our days in the care of people with cardiovascular disease. In the office or making rounds in the hospital, we prescribe drugs and order diagnostic tests; in the noninvasive laboratory, we obtain and interpret images of the heart; in the electrophysiology and cardiac catheterization laboratories, we program and implant devices in patients. When antithrombotic and fibrinolytic drugs are administered, and primary percutaneous coronary intervention is done using balloon catheters and intracoronary stents, lives are saved among patients with acute myocardial infarction. Response by Avorn and Choudhry see p 2227The mortality risk from heart failure decreases and quality of life increases from the proper and appropriate use of angiotensin-converting enzyme inhibitors and ␤-blockers. Lipid lowering through the use of statin drugs saves lives and reduces serious cardiovascular complications such as myocardial infarction and stroke when properly prescribed to patients with a variety of manifestations of atherosclerotic vascular diseases. According to a recent publication by Ford and colleagues, 3 deaths due to coronary heart disease in the United States declined substantially from 1980 to 2000, resulting in Ͼ340 000 fewer deaths in 2000. The authors attributed approximately half of this decline to changes in cardiac risk factors and half to the application of evidencebased therapies. An underlying theme in all of this is that the pharmaceutical, biotechnology, and device industries produce an enormous amount of public good through their investment in drug and device discovery, development, and research.Likewise, education of the clinical practice community ensures that clinicians are familiar with the latest developments and advances in cardiac care so that they might be offered to our patients. Failure to implement evidence-based prescribing carries significant consequences for patients. Peterson and colleagues 4 have shown that among patients with acute coronary syndromes, a 10% increase in guideline adherence translates to a corresponding decrease in inhospital mortality. The mortality risk of patients with acute coronary syndromes has dropped by Ͼ30% in the past 15 years. 5

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A Randomized Trial of a Program to Reduce the Use of Psychoactive Drugs in Nursing Homes

Abstract: An educational program targeted to physicians, nurses, and aides can reduce the use of psychoactive drugs in nursing homes without adversely affecting the overall behavior and level of functioning of the residents.

Cited by 348 publications

References 21 publications

How Can We Increase Translation of Research into Practice? Types of Evidence Needed

How Can We Increase Translation of Research into Practice? Types of Evidence Needed

‘Bench To Behavior’: Translating Comparative Effectiveness Research Into Improved Clinical Practice

Funding for Medical Education: Maintaining a Healthy Separation From Industry

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