Table 2 Key events that could have influenced GMS physicians' propensity to use thiazide-based regimens for their hypertensive patients

December 18, 2002

Main results of ALLHAT is published in JAMA, with extensive coverage of the study in lay press.

Early January 2003

GMS Chief observes a pharmaceutical representative give a pre-clinic talk about amlodipine for hypertension to GMS trainee physicians. Representative's talk is followed by a presentation given by a GMS physician on the ALLHAT trial and the cost-effectiveness of thiazides for hypertension. After discussing this at a section meeting and concluding that trainees are getting mixed messages, GMS decides to ban pharmaceutical representatives from the GMC area.

August 23, 2003

During GM Section meeting, chief announces that a deputy secretary of the Department of Veterans Affairs has stated that he will return any financial saving reaped by increased use of thiazide-based regimens to the VA medical center that generated them. Section discusses opportunity to gain funds to support a much-needed additional clinician. (This financial incentive never materialized.)

October 3, 2003

GMS chief circulates a draft to GMS members describing a potential ALLHAT Implementation Project.

October 9, 2003

During GM Section meeting, section decides to go forward with project as delineated in its October 3 draft. Chief announces possibility that a new "implementation research" funding initiative might be launched by the VA HSR&D in Washington, DC.

October 22, 2003

VA HSR&D issues call for implementation planning-grant proposals, due by November 15, 2003.

November 13, 2003

GMS submits proposal for its ALLHAT Implementation Project to VA HSR&D.

December 17, 2003

GMS notified that it has been awarded a $50,000, six-month grant for its ALLHAT Implementation Project

January 15, 2004

Formal project kickoff meeting with full Steering Committee

June 25, 2004

For the first time group-level data for thiazide use and blood pressure goal attainment in GMS vs. PrimeCare became available for review. Project steering committee (consisting of entire project team) reviews and discusses data. (Panel level data were not available during the intervention period.)

September 30, 2004

End of active implementation efforts.

December 9, 2004

Formal close of ALLHAT Implementation Project at a GM Section meeting.