Comparing the efficacy of staff versus housestaff instruction in an intervention to improve hypertension management

Purpose. To determine whether a resident physician can be as effective as a faculty opinion leader in changing physicians' compliance with a hypertension practice guideline. Method. At a general internal medicine clinic associated with an internal medicine residency program, sequential charts were reviewed for patients with uncontrolled or new-onset hypertension who were seen routinely during a two-week period. Subsequently, 23 providers were randomly assigned to an academic intervention to implement a hypertension practice guideline led by a single second-year resident instructor (RI), and 21 providers were assigned to the same intervention led by a single staff internist (SI) with an interest in hypertension. The intervention involved academic detailing, chart audit with feedback, and behavior reinforcement. Six weeks later, the chart audit was repeated to assess the change in practice patterns among providers taught by the RI compared with those taught by the SI. Results. Overall, management consistent with the practice guideline improved from 32% (51/157) to 45% (56/123) (P < .01) after the intervention. This change was due to improvement in the care provided by providers from the SI-led intervention: 28% (17/60) to 57% (26/46) (P < .003). Providers from the RI-led intervention showed no improvement: 35% (34/97) to 39% (30/77) (p = NS). Conclusions. This intervention was effective in improving providers' compliance with a hypertension practice guideline, but only when led by a faculty opinion leader. A resident instructor using the same format was unable to change the providers' behaviors.