The goal of this project, in response to AHCPR RFA:HS-92-03, is to improve the outcomes of pharmaceutical therapies in ambulatory settings by providing opinion leaders and thus practicing physicians with up-to- date pooled results from meta-analyses (M-As) of randomized controlled trials (RCTs) of drug comparisons using our recently developed methods, cumulative meta-analysis (CMA), and creating a Real-Time Meta- Analysis System to facilitate experts knowledge base and facilitate the prompt recognition of effective and the appropriate use of ambulatory pharmaceutical therapies. Three clinical areas have been chosen that: 1) afflict large numbers of the population; 2) disorders for which a large number of RCTs or alternative pharmaceuticals are available; 3) where alternative therapies have wide ranging cost implications; and 4) those not currently being evaluated in AHCPR PORT projects. These three areas are: antibiotic usage, hypertension, and congestive heart failure. Specifically, our aims are to: 1) to develop the RTMAS, by applying the techniques of CMA and a matrical method of organizing RCT data and M-A results; 2) to develop comprehensive databases of RCTs in the three clinical areas and perform CMAs of RCTs to determine the efficacy of ambulatory pharmaceuticals; 3) to dissemination RCT databases and M-A results to opinion leaders, practicing physicians, and researchers; 4) to test the hypothesis that opinion leaders are as inconsistent and lagging in response to published RCTs in the ambulatory field as they are in the inpatient setting; and 5) to assess the impact of M-As on opinion leader recommendations. Over a four-year period, the following tasks will be done to accomplish these aims: 1) develop a computer-based RTMAS to organize, routinely update and display RCTs and M-As of ambulatory pharmaceuticals in the clinical areas in an efficient, easy-to-use, and easy-to-understand matrix format;2) develop and maintain up-to-date databases of RCTs and M-As in the following clinical mentioned above; 3) update previously published M-As and applying CMAs to determine the efficacy and outcomes of the ambulatory use of the above pharmaceutical therapies; 4) disseminate M-As by publication in appropriate journals and to opinion leaders; 5) monitor opinion leader recommendations published in journal review articles and textbook chapters and comparing their recommendations with CMAs; 6) study the impact of published M-As on opinion leader recommendations by performing citation-analyses.
