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Towards Improved Outcomes from the Use of the Prostate Specific Antigen Test

May FW, Rowett DR, Clark RB, Stone C, Pinnock C, Esterman A, Elwood M, Jubb C.

Drug and Therapeutics Information Service (DATIS), University of Queensland and Repatriation General Hospital, Daw Park, South Australia

1. the objective of the study;
    
   To demonstrate proof-of-concept for a national program for more informed use of the PSA test by Australian Family Physicians.
    
2. the outcomes, control measures and key learning points;
    
   The trial is in two parts:
    
   1. A random controlled trial in metropolitan Melbourne. 240 family physicians were randomly assigned to three groups: academic detailing plus PSA-test ordering feedback; academic detailing without test ordering feedback; control group.
       
   2. A quasi-experimental academic detailing programme comprising approximately 200 family physicians each in contiguous postcodes in Brisbane and Adelaide. Using a demographically similar comparison area to estimate background trends, evaluations of aggregated age-differentiated PSA-test rates measured before and after visits.
       
3. population studied;
    
   Over 550 practicing general practitioners have been recruited to the study.
    
4. the healthcare setting in which the study occurred;
    
   General practice/family physicians in community primary care practice.
    
5. whether the results are generalizable;
    
   The study design and the sample size are aimed at providing generalizable conclusions.
    
6. standard/prior practice for comparison, if applicable;
    
   Randomized Controlled Trial arm includes control group, which receives no intervention. Quasi-experimental arm includes control geographic samples that are nave to the intervention.
    
7. intended/hypothesized outcome;
    
8. Increased physician knowledge regarding risks of prostate cancer and diagnosis amongst males, decreased self-reported intention to test in 75 years old males; decreased individual PSA test ordering rates in age groups >70 years
    
9. Uptake of academic detailing service; aggregated geographic data to show decreased PSA test ordering rates in age groups >70 years
    

1. results of study or ongoing monitoring of effectiveness.

   Interim questionnaire results show statistically significant increased knowledge regarding risk of prostate cancer and self-reported decreased likelihood of ordering PSA tests in males aged 75 years. PSA testing data currently being extracted from national Medicare database.