Printed educational materials directed at Ontario primary care physicians fail to improve adherence to guideline recommendations for the management of diabetes complications: a pragmatic, factorial, cluster randomized trial
Abstract
Printed educational materials (PEMs) have long been used as a tool for knowledge translation despite the conflicting evidence surrounding their effectiveness. A pragmatic, 2x2 factorial, cluster-randomized controlled trial was designed to ascertain the effectiveness of two distinct formats of a PEM (insert and outsert) at improving adherence to guideline recommendations for the management of diabetes complications among Ontario family and general practitioners. Administrative databases were used to compare patient’s treatment regimens at baseline and one year following PEM mailout to determine whether prescription rates intensified in response to the PEMs. A total of 4,118 practices (4,957 physicians) and 185,454 patients were included. Intensification rates in the four groups were similar and approximately equal to 46%. In intention-to-treat analyses, no treatment effect was found with the insert (OR 0.99, 95% CI 0.96 to 1.02), nor with the outsert (OR 1.01, 95% CI 0.98 to 1.04). Thus, PEMs were not effective at improving physician’s adherence to guidelines for diabetes care.