Are postal prompts really ineffective?

BMJ 1999;319:711- ( 11 September )

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Are postal prompts really ineffective?

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EDITOR $---$ Given the evidence presented in the POST study, a well designed cluster randomised trial, we were a little surprisedthat the investigators concluded that postal prompts to generalpractitioners have a "marginal role" in improving the secondaryprevention of coronary heart disease.¹

The authors found that recording and advice were significantly increased for all except one of the measures of risk factor,dramatically so for some measures (such as recorded cholesterolmeasurement). Also, for their principal prescribing outcome measures( $beta$ blockers and cholesterol lowering drugs), the odds ratio wasnon-significantly raised to 1.7 $---$ which, if real, seems clinicallyimportant. The failure to detect a statistically significant differencemay reflect the absence of a real effect or simply a type 2 errordue to insufficientpower.

We agree that the overall level of prescribing of $beta$ blockers and cholesterol lowering drugs in both arms of the study wasdisappointing. The finding that . . . [Full text of this article]

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Relevant Article

Effect of postal prompts to patients and general practitioners on the quality of primary care after a coronary event (POST): randomised controlled trial: Gene Feder, Chris Griffiths, Sandra Eldridge, and Matthew Spence
BMJ 1999 318: 1522-1526. [Abstract] [Full Text] [PDF]

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