Arq Bras Cardiol: Imagem cardiovasc 2021; 34(4): eabc249

Frequency and Characteristics of Responders to an Educational Intervention to Reduce Inappropriate Heart Testing: A Sub-study of the Echo WISELY Trial

DOI: 10.47593/2675-312X/20213404eabc249

Abstract

Introduction

The Echo WISELY Trial is a controlled randomized multicenter investigator-blinded study that evaluated an educational intervention based on the criteria for appropriate use of echocardiography to reduce the proportion of rarely appropriate outpatient echocardiograms performed.

Objective

To describe the prevalence and identify predictors of the responsiveness of responding physicians subjected to an educational intervention in the Echo WISELY Trial.

Methods

The intervention group physicians received a multifaceted educational program. A responding physician was defined as one who had a >2.5% reduction in the proportional mean of rarely appropriate tests requested between the first trimester (baseline) and any of the following trimesters (second to sixth). Physician characteristics (sex, time since graduation, medical specialty, and workplace) were compared to the echocardiogram ratings (appropriate, maybe appropriate, and rarely appropriate) and clinical reasons for the requested echocardiograms using the chi-square test. Statistical significance was indicated by a two-tailed p < 0.05.

Results

A total of 4,605 tests requested at the six participating hospitals in Ontario were analyzed and randomized for the intervention arm. Of the 36 included physicians, 26 (72%) were classified as responders. Of the variables analyzed, there was no significant difference in the outcomes of the responders versus non-responders to the educational intervention. The number of rarely appropriate tests requested by the responders was significantly lower than that of the non-responders (234 [8.67%] versus 261 [13.8%]; p < 0.0001).

Conclusion

The prevalence of responder physicians was high, but predictors of responsiveness to educational intervention were not identified among the analyzed variables. This may be a result of the psychological aspects and personal characteristics of the physicians, which were not included in this research.