Healthy Skepticism Library item: 17813

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Publication type: Journal Article

Stafford RS, Bartholomew LK, Cushman WC
Impact of the ALLHAT/JNC7 Dissemination Project on Thiazide-Type Diuretic Use
Arch Intern Med 2010 May 24; 170:851-858.
http://www.cardiosource.com/cjrpicks/CJRPick.asp?cjrID=5901

Abstract:

Study Question: What was the impact of Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) results on physician practice patterns?
Methods: To improve discrimination and adoption of changes in practice management resulting from landmark trials and changes in guidelines, specific strategies are considered. Academic detailing incorporates several approaches used in pharmaceutical marketing including use of investigator-educators as opinion leaders, and communication of antihypertensive management through individualized small groups. Two national databases were used to evaluate this academic detailing model. The National Disease and Therapeutic Index is a physician-based survey, which surveys approximately 4,800 physicians every 3 months; data collection included prescribing information on antihypertensives. Data from this survey overlapped with academic detailing efforts in 176 counties from 38 states. The IMS Health Xponent database is a national computerized sample of approximately 36,000 retail pharmacies. Practice patterns prior to 2004 and in 2007 were compared. In addition, national trends in use of thiazide type diuretics were examined for an 8-year time period (2000-2008).
Results: The ALLHAT findings were published in 2002. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) was published in 2003. Survey data showed that thiazide-type diuretic use increased in most in US counties where academic detailing activity was the greatest (an increase from 37.9% to 46.5%, p < 0.05) compared to counties where activity was moderate or low. Pharmacy dispensing data showed that thiazide-type diuretic prescriptions increased by 8.7% in counties with dissemination project activities compared to 3.9% in counties without such activities (p < 0.001). On a national level, thiazide-type diuretic use did not increase between 2004 and 2008.
Conclusions: The investigators suggest the ALLHAT/JNC7 dissemination project was associated with a small effect on thiazide-type diuretic use, demonstrating that academic detailing may increase physician implementation of clinical trials.
Perspective: These findings suggest a modest adoption of thiazide diuretics, as recommended by the ALLHAT findings and JNC7. However, this project was initiated 2 years after the publication of ALLHAT; thus, antihypertensive management may have already undergone significant changes. Further research would be needed to understand specific factors related to the adoption of recommendations for control of blood pressure.