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Academic Detailing For Better Use of Prostate Specific Antigen Testing

D. Weller¹, F. May², D. Rowett³, L. Quinn³, C. Pinnock⁴, S. Nicholson⁵, and A. Esterman⁵

¹Department of General Practice, University of Edinburgh, Edinburgh, United Kingdom;
²Drug and Therapeutic Information Service (DATIS) College of Pharmacy, Lexington, KY USA;
³DATIS - Pharmacy Department and ⁴Department of Surgery, Repatriation General Hospital, Daw Park, SA, 5041;
⁵Department of General Practice, Flinders University, Adelaide, SA, 5042

A randomised controlled trial in Australia has evaluated academic detailing as a technique for achieving better use of PSA testing by primary care physicians. Use of PSA tests for screening purposes in primary care practice is widespread, but current recommendations confirm that there is insufficient evidence to determine whether benefits outweigh harms for a screened population. 145 consenting GPs were randomised to receive a multi-faceted educational intervention consisting of two academic detailing visits (6-8 weeks apart) where clinical guidelines and written patient materials were delivered together with feedback on past use of PSA tests relative to use by other GPs. Printed materials plus PSA testing rates were delivered via mail to a second intervention group. A third group served as controls. Knowledge about prostate cancer and PSA testing was estimated before and after intervention, and PSA testing rates per 100 male consultations were measured, six months prior, six months after, and twelve months after the intervention. Physician knowledge was significantly improved in four of five areas six months after visits, and in one of the five areas after mailed delivery of materials. For the period 0-6 months after the intervention, there was a 27 percent increase in median PSA testing per 100 male consultations in the control group, 6 percent increase in the mailed group and a 17 percent decrease in the academic detailing group. Testing rates only significantly differed for the detailing group where patients were over 70 years of age. For the period 6-12 months after the intervention, no significant differences were found between groups. Academic detailing is an effective way to improve primary care provider knowledge and discrimination in use of PSA tests.