[Oral or sublingual nifedipine: utility and long-term effectiveness of medical education to decrease its use in...

Despite the severe side effects reported, short acting nifedipine compounds (oral or sublingual) are still widely used for the considered hypertensive emergencies. The objective of this study was to study the effect of simple medical education measures on the prescription of such compounds in our institution.

In a previous survey we found that 67% of physicians involved in the care of hypertensive emergencies at our institution considered oral/sublingual nifedipine the therapy of choice. The recommendations in the JNC VI document were reviewed in a Clinical Session and each participating physician was provided with a translated copy and a letter with the reasoned answer. The Pharmacy Department provided a list of patients with the prescriptions of nifedipine upon request and programmed in the Emergency Department, Medical and Surgical Departments. Four time periods were considered: first or control (pre-session): September 1997-March 1998; second (immediately post-session): June 1998-December 1998; third (9-12 months post-session): January 1999-June 1999, and fourth (28-34 months post-session): September 2000-March 2001. At a later session the results were presented and a summary of results was submitted to Departments with a consensus note on the prescription of short acting nifedipine compounds.

There were significative decrements in urgent and total doses and treated patients during the periods considered. This effect was sustained and in a three-year period reductions of 78% (Emergency Room), 91% (Medical Services) and 79% (Surgical Services) of prescriptions were noted.

Simple measures of continuous medical education (scientific meetings, personal letters and facilitated access to scientific evidence) were highly effective in reducing prescriptions of short-acting nifedipine at our centre.