Opinion leaders positively influence AMI therapy
Aspirin, beta blocker use increase after intervention
A recent study illustrates the potential impact of cultivating and supporting respected clinicians who can act as quality champions.1 Working with opinion leaders and providing performance feedback, say investigators, can accelerate the adoption of beneficial acute myocardial infarction (AMI) therapies such as aspirin and beta blockers and eliminate outdated practices such as prophylactic lidocaine.
Stephen B. Soumerai, ScD, of Harvard Medical School and Harvard Pilgrim Health Care, both in Boston, and colleagues identified local opinion leaders who, through group discussions, informal consultations, and revisions of clinical pathways, influenced their peers. The opinion leaders took part in an intervention that focussed on increasing the use of highly effective drugs for eligible AMI patients - beta blockers for all patients and aspirin and thrombolytics in the elderly - and reducing routine use of lidocaine. Lidocaine is given to heart attack patients to reduce the risk of ventricular fibrillation but can cause death.
The investigators looked at 5,000 patients at 37 community hospitals and controls. The researchers compared the proportion of patients who received study drugs over 10 months before and after the intervention period and found that "Overall, the intervention resulted in a significant increase in aspirin and beta blocker use." There was a 17% increase in aspirin use among elderly patients and a 4% decrease at control hospitals.
The proportion of eligible patients receiving beta blockers increased by 63% after intervention, compared to a 30% increase at control hospitals. The decline in the use of lidocaine was about the same at all hospitals.
"We observed an approximate 50% reduction in the proportion of ineligible patients receiving lidocaine to about 10% after the intervention in both experimental and control hospitals," the researchers said.
The authors conclude: "Our study suggests that, when best practices are clearly defined by national consensus guidelines and rigorous evidence, guided quality improvement interventions using local opinion leaders can accelerate adoption of effective treatments in community practice."
Reference:
1. Soumerai SB, McLaughlin TJ, Gurwitz JH, et al. Effect of local medical opinion leaders on quality of care for acute myocardial infarction: A randomized controlled trial. JAMA 1998; 279:1,358-1,363.
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