Time trend analysis and variations in prescribing lipid lowering drugs in general practice.

These findings have implications for the strategies used to encourage general practitioners to base their practice on clinical evidence. Teaching general practitioners critical appraisal skills and developing guidelines may redress identified skill deficiencies and distil trial data in accessible form, but universal awareness and acceptance of trial findings alone may not lead to their integration into everyday practice. Strategies to maximise evidence based practice may not work if they fail to recognise the judgments general practitioners already make about trial data and the process by which trial data become practically applicable. Our findings confirm that strategies are more likely to be effective if they recognise and build on developing informal consensus about trial data. Imminent organisational changes within the NHS 1 2 provide the impetus to manage this process purposefully so that it links individual general practitioners' application of trial data to effective use of local resources, chiefly cash limited prescribing budgets, to meet local needs. This requires cooperation and negotiation among important local players—for instance, primary care groups (local health care cooperatives in Scotland), primary and secondary care trusts, and local health authorities—so that this consensus is formalised and made transparent. We thank all the participating general practitioners, consultants, and health board staff who generously gave of their time and knowledge, and Sally Wyke, senior research fellow for her support, advice, and theoretical input throughout the study. Contributors: KF initiated the project. KF and GH designed the study, collected and analysed the data, and wrote the paper. KF and GH are joint guarantors of the work. General practitioners' perceptions of the route to evidence based medicine: a questionnaire study. A study of general practitioners' reasons for changing their prescribing behaviour. Prevention of coronary heart disease with pravastatin in men with hyper-cholesterolemia. The West of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin. A comparison of three methods of setting prescribing budgets derived from DDD analyses of historic patterns of use. al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol. The first trial to show that patients with coronary heart disease treated with lipid lowering drugs gained a survival advantage was published in November 1994. 1 Other similar trials that used hydroxymethyl glutaryl coenzyme A (HMG-CoA) reductase inhibitors, or stat-ins, have subsequently confirmed these results (Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group, 70th scientific sessions of …