Article type
Year
Abstract
Introduction/Objective: Menorrhagia is a significant health care problem. There is a lack of evidence-based management of menorrhagia in both primary and secondary care. A research-practice gap hinders the introduction of 'best practice'. This paper describes an evidence-based package with which we set out to influence the prescribing pattern of medical treatments in primary care, referral rates from primary to secondary care, and the rate of hysterectomy for menorrhagia.
Methods: A standardised evidence-based presentation using audiovisual, graphic and written educational materials was given in an interactive small group forum with an independent academic resource. A six month follow-up meeting with feedback and critical appraisal of a guideline document was held, to reinforce change in physician behaviour. Outcome measures are: physician satisfaction, pre and post education knowledge, prescribing trends, and a practice based audit of referral patterns. Regional secondary care units were randomised to receiving an early or late educational package which consisted of a standardised evidence-based presentation to the clinical staff using audiovisual means and introducing the Levonorgestrel IUD as a treatment option for menorrhagia. Outcomes are hysterectomy rates and patient satisfaction.
Results: 99/305 practices in the region are participating in the study. Wholesale sales figures suggest that with respect to adjacent counties the East Anglian region has seen an increase in sales of the most appropriate drugs for menorrhagia treatment (e.g. Tranexamic Acid) and a fall in the least appropriate drug (Norethisterone). Thus far 93 lUDs (total cost 9300 pounds) have been used in women, considered for therapeutic surgery. We estimate a saving in the order of 116,000 pounds based on all procedures being a total abdominal hysterectomy.
Discussion: A large number of general practitioners arc participating in the Anglia Menorrhagia Education Study (AMRS). There are indications that their prescribing behaviour has changed as a result. The option of the levonorgestrel IUD as an alternative to surgical intervention has been taken up by women referred to secondary care. Further data is being collected to support these preliminary conclusions.
Methods: A standardised evidence-based presentation using audiovisual, graphic and written educational materials was given in an interactive small group forum with an independent academic resource. A six month follow-up meeting with feedback and critical appraisal of a guideline document was held, to reinforce change in physician behaviour. Outcome measures are: physician satisfaction, pre and post education knowledge, prescribing trends, and a practice based audit of referral patterns. Regional secondary care units were randomised to receiving an early or late educational package which consisted of a standardised evidence-based presentation to the clinical staff using audiovisual means and introducing the Levonorgestrel IUD as a treatment option for menorrhagia. Outcomes are hysterectomy rates and patient satisfaction.
Results: 99/305 practices in the region are participating in the study. Wholesale sales figures suggest that with respect to adjacent counties the East Anglian region has seen an increase in sales of the most appropriate drugs for menorrhagia treatment (e.g. Tranexamic Acid) and a fall in the least appropriate drug (Norethisterone). Thus far 93 lUDs (total cost 9300 pounds) have been used in women, considered for therapeutic surgery. We estimate a saving in the order of 116,000 pounds based on all procedures being a total abdominal hysterectomy.
Discussion: A large number of general practitioners arc participating in the Anglia Menorrhagia Education Study (AMRS). There are indications that their prescribing behaviour has changed as a result. The option of the levonorgestrel IUD as an alternative to surgical intervention has been taken up by women referred to secondary care. Further data is being collected to support these preliminary conclusions.