Improving prescribing of antihypertensive and cholesterol-lowering drugs: a method for identifying and addressing barriers to change

We used structured reflection, searched for other relevant trials, surveyed general practitioners and talked with physicians during pilot testing of the intervention. The post hoc exercise was carried out as focus groups of international researchers in the field of quality improvement in health care. The post hoc survey was done by telephone interviews with physicians allocated to the experimental group of a randomised trial of our multifaceted intervention.A wide range of barriers was identified and several interventions were suggested through structured reflection. The survey led to some adjustments. Studying other trials and pilot testing did not lead to changes in the design of the intervention. Neither the post hoc focus groups nor the post hoc survey revealed important barriers or interventions that we had not considered or included in our tailored intervention.A simple approach to identifying barriers to change appears to have been adequate and efficient. However, we do not know for certain what we would have gained by using more comprehensive methods and we do not know whether the resulting intervention would have been more effective if we had used other methods. The effectiveness of our multifaceted intervention is under evaluation in a randomised controlled trial.Much research has been carried out with the aim of influencing the performance of clinicians. The results have varied [1,2]. As with any human behaviour, clinical practice is difficult to change. Some strategies that have been evaluated, like passive dissemination of clinical practice guidelines, have had little or no effect on practice [3]. Others, like educational outreach visits ("academic detailing") and multifaceted interventions, may be more effective than passive interventions [1].The reasons why clinical practice sometimes is not consistent with current best evidence varies across clinical problems and from one clinician to another. A logical consequence of this is to tailor quality improv