Overview of the eight projects
Project | Reduction in the inappropriate use of: | Setting | Problem analysis data source | Design | De-implementation strategy | Effect evaluation data source | Process evaluation data source |
1 | Inhaled corticosteroids for patients with mild chronic obstructive pulmonary disease | Five primary care cooperation groups, with a total of five pharmacists and 40 general practices | Focus group interviews with clinicians and patients | A before-and-after study with a national control group | Education of GPs and pharmacists. Publications in patient and professional magazines. Selection of patients whose use of inhaled corticosteroids was potentially unnecessary. Patient information | National database | Survey among clinicians and patients |
2 | Surveillance CT scans for patients cured of lymphoma | Nine hospitals’ haematology wards | A survey among clinicians and patients | A before-and-after study with a national control group | Education of haematologists. Patient information (leaflet). Presentation at a patient association conference | National database | Survey among clinicians |
3 | Knee arthroscopies and MRIs for orthopaedic patients aged 50 years or older | Thirteen orthopaedic centres | Interviews and surveys among clinicians and patients | A difference-in-difference design with a national control group | Appointing clinical champions. Education of orthopaedic specialists. Patient information (leaflet). Feedback | National database | Survey among clinicians |
4 | Intravenous and urinary catheters | Seven hospitals’ internal medicine and non-surgical subspecialty wards | A survey among patients and observations in clinical practice | A before-after study with an interrupted time series analysis | Appointing clinical champions. Education of physicians and nurses. Use of educational materials (poster, pocket card). Patient information (leaflets). Competitive feedback. Changes in the structure of medical records | Patients’ medical records | Observations in clinical practice |
5 | Vitamins D and B12 tests | Twenty-six primary care health centres, with a total of 158 general practitioners | Experience from an earlier pilot study | Cluster randomised study comparing two interventions | Education of GPs and feedback in intervention groups A and B. Patient information (leaflet, video clip and poster) in intervention group B only | Regional database | Interviews with clinicians and patients |
6 | Diagnostic laboratory tests | Four hospitals’ internal medicine wards | Experience from an earlier pilot study and a survey among clinicians | A before-after study with an interrupted time series analysis and a control group of 19 hospitals | Conferences for physicians. Increased supervision of residents. Education of physicians. Feedback. Changes in the ordering system | Hospital registries | Survey among clinicians |
7 | Surveillance visits for patients cured for basal cell carcinoma | Three hospitals’ dermatology wards | Interviews and focus group interviews with clinicians and patients | An uncontrolled before-and-after study | Personalised patient information | A survey among patients | Interviews with clinicians and patients |
8 | Upper gastrointestinal endoscopies for dyspeptic patients | Four hospitals’ gastroenterology wards | Focus group interviews with clinicians and patients | A randomised controlled trial | Interactive e-learning for patients | Patients’ medical records | A survey among patients |