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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.

Randomised, controlled crossover pilot study on the efficacy of Intranet-based guidelines for General Internal Medicine at the Park-Klinik Weissensee in Berlin. As part of the evaluation programme for the intranet-based internal guideline system at the Park-Klinik Weissensee in Berlin, an experimental randomised, controlled trial was conducted in which 12 medical students in their final year were asked to solve 10 clinical vignettes each. A number of written and electronic sources of medical information was available. In addition, the students were allowed to use the internal guideline system for one half of the vignettes in a crossover fashion. There was a sample size-related non-significant trend in favour of the guideline system concerning the primary endpoint "time to right solution" (mean 2.8 min; 95% CI -1.6 to 7.3). A per-protocol-analysis revealed a great variability in the actual use of the guidelines available. There was an inverse "dose-response relationship" between the intensity of guideline usage and the endpoint.