Group versus individual academic detailing to improve the use of antihypertensive medications in primary care: a cluster-randomized controlled trial

Am J Med. 2005 May;118(5):521-8. doi: 10.1016/j.amjmed.2004.12.023.


Purpose: To compare group versus individual academic detailing to increase diuretic or beta-blocker use in hypertension.

Methods: We conducted a cluster-randomized controlled trial in a large health maintenance organization. Subjects (N=9820) were patients with newly treated hypertension in the year preceding the intervention (N=3692), the 9 months following the intervention (N=3556), and the second year following intervention (N=2572). We randomly allocated 3 practice sites to group detailing (N=227 prescribers), 3 to individual detailing (N=235 prescribers), and 3 to usual care (N=319 prescribers). Individual detailing entailed a physician-educator meeting individually with clinicians to address barriers to prescribing guideline-recommended medications. The group detailing intervention incorporated the same social marketing principles in small groups of clinicians.

Results: In the first year following the intervention, the rates of diuretic or beta-blocker use increased by 13.2% in the group detailing practices, 12.5% in the individual detailing practices, and 6.2% in the usual care practices. As compared with usual care practices, diuretic or beta-blocker use was more likely in group detailing practices (adjusted odds ratio (OR), 1.40; 95% confidence interval (CI), 1.11 - 1.76) and individual detailing practices (adjusted OR, 1.30; 95% CI, 0.95 - 1.79). Neither intervention affected blood pressure control. Two years following this single-visit intervention, there was still a trend suggesting a persistent effect of individual (OR, 1.22; 95% CI, 0.92 - 1.62), but not group, detailing (OR, 1.06; 95% CI, 0.80 - 1.39), as compared with usual care.

Conclusion: Both group and individual academic detailing improved antihypertensive prescribing over and above usual care but may require reinforcement to sustain improvements.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adrenergic beta-Antagonists* / economics
  • Adult
  • Aged
  • Antihypertensive Agents / economics
  • Antihypertensive Agents / therapeutic use*
  • Cost-Benefit Analysis
  • Diuretics / economics
  • Diuretics / therapeutic use*
  • Drug Costs
  • Drug Utilization / standards*
  • Education, Medical, Continuing / methods*
  • Female
  • Guideline Adherence
  • Health Maintenance Organizations / standards*
  • Humans
  • Hypertension / drug therapy*
  • Logistic Models
  • Male
  • Middle Aged
  • New England
  • Practice Guidelines as Topic
  • Primary Health Care / standards
  • Social Marketing*


  • Adrenergic beta-Antagonists
  • Antihypertensive Agents
  • Diuretics