What difference does training make? A randomized trial with waiting-list control of general practitioners seeking advanced training in drug misuse.

Abstract

To measure changes in knowledge, attitudes and clinical practice of general practitioners (GPs) enrolled to receive training in the management of drug misusers. Two-group randomized trial with training (T) and waiting-list (WL) control comparison conditions. A total of 112 GPs working in primary care practices in England. A 6-month, part-time, mixed-methods training course provided by the Royal College of General Practitioners. GPs randomized to the WL control received no special training or guidance during the study period. Knowledge, therapeutic attitudes (commitment, role security, situational constraints and prescribing confidence) and clinical practice behaviour change (numbers of drug misusers seen, treated). Intention-to-treat/train (ITT) analysis, supplemented by treatment/training received (TR) analysis. Training applicants had positive attitudes towards and were already involved in the care of drug misusers. Improvements in attitudes and behaviour were greatest among the T group, although only 'role security' and 'situational constraint' reached statistical significance (ITT). A subgroup in the WL group circumvented their allocation and received training, prompting supplementary analysis by TR. Overall, GPs who received training showed markedly greater improvements in knowledge, attitudinal and prescribing confidence measures and remained more actively involved in treating drug misusers than GPs who remained in the WL control group (TR analysis). GPs seeking special training for the care of drug misusers are both positively disposed to this patient population and clinically active. Benefits unambiguously attributable to the course were modest. While a TR effect was observed, strict adherence to ITT analysis failed to identify significant benefits observed with the training provided. Randomisation and waiting-list controls design are insufficient as a research method for training evaluation studies if ITT analysis is used exclusively.