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Impact of short evidence summaries in discharge letters on adherence of practitioners to discharge medication. A cluster-randomised controlled trial
  1. R Kunz1,
  2. K Wegscheider2,
  3. G Guyatt3,
  4. W Zielinski4,
  5. N Rakowsky5,
  6. N Donner-Banzhoff6,
  7. S Müller-Lissner5
  1. 1
    Basel Institute for Clinical Epidemiology (BICE), University Hospital Basel, Basel, Switzerland
  2. 2
    Department for Statistics and Econometry, University of Hamburg, Hamburg, Germany
  3. 3
    Department of Clinical Epidemiology and Biostatistics, CLARITY Research Group, Clinical Advancement through Research and Information Translation, McMaster University, Hamilton, Ontario, Canada
  4. 4
    Oberlinklinik, Ref. Organisation, Orthopädische Fachklinik im Verein Oberlinhaus, Potsdam, Germany
  5. 5
    Department for Internal Medicine, Park-Klinik Weissensee, Berlin, Germany
  6. 6
    Department of General Practice, Prevention and Rehabilitation, Philipps University Marburg, Marburg, Germany
  1. Professor R Kunz, Basel Institute for Clinical Epidemiology, University Hospital Basel, Hebelstrasse 10, CH-4031 Basel, Switzerland; rkunz{at}


Background: International concern about quality of medical care has led to intensive study of interventions to ensure care is consistent with best evidence. Simple, inexpensive, feasible and effective interventions remain limited.

Objective: We examined the impact of one-sentence evidence summaries appended to consultants’ letters to primary care practitioners on adherence of the practitioners to recommendations made by the consultants regarding medication for patients with chronic medical problems.

Design: Cluster-randomised trial.

Setting: Secondary/primary care interface (urban district hospital/referral practices).

Participants: 178 practices received one or more discharge letters with evidence summaries. The 66 practices in the intervention group provided feedback on 172 letters, and the 56 practices in the control group provided feedback on 96 letters.

Results: Appending an evidence summary to discharge letters resulted in a decrease in non-adherence to discharge medication from 29.6% to 18.5% (difference adjusted for underlying medical condition 12.5%; p = 0.039). Among the five possible reasons for discontinuing discharge medication, the evidence summaries seemed to have the largest impact on budget-related reasons for discontinuation (2.6% in the intervention versus 10.7% in the control group (p = 0.052)). Most clinicians (72%) were enthusiastic about continuing receiving evidence summaries with discharge letters in routine care.

Conclusions: The one-sentence evidence summary is a simple, inexpensive, well-accepted intervention that may improve primary care practitioners’ adherence to evidence-based consultant recommendations.

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  • The study sponsor had no role in the study design, collection, analysis, and interpretation of data.

    The practitioners in the catchment area received written notification regarding the project before its commencement. We interpreted willingness to answer follow-up questions as denoting informed consent. The ethics committee of the University Hospital Charité, Berlin, Germany provided ethical approval.

  • Funding: Financial support was provided by the Techniker Krankenkasse, Hamburg, Germany. RK was supported by a research grant from the Senat of Berlin, Germany; Santésuisse and the Gottfried und Julia Bangerter-Rhyner-Stiftung, Switzerland.

  • Competing interests: None.