O'Connell D L, Henry D, Tomlins R
Discipline of Clinical Pharmacology, Faculty of Medicine and Health Sciences, University of Newcastle, New South Wales, Australia.
BMJ. 1999 Feb 20;318(7182):507-11. doi: 10.1136/bmj.318.7182.507.
To evaluate the effect on general practitioners' prescribing of feedback on their levels of prescribing.
Randomised controlled trial.
General practice in rural Australia.
2440 full time recognised general practitioners practising in non-urban areas.
Two sets of graphical displays (6 months apart) of their prescribing rates for 2 years, relative to those of their peers, were posted to participants. Data were provided for five main drug groups and were accompanied by educational newsletters. The control group received no information on their prescribing.
Prescribing rates in the intervention and control groups for the five main drug groups, total prescribing and potential substitute prescribing and ordering before and after the interventions.
The intervention and control groups had similar baseline characteristics (age, sex, patient mix, practices). Median prescribing rates for the two groups were almost identical before and after the interventions. Any changes in prescribing observed in the intervention group were also seen in the control group. There was no evidence that feedback reduced the variability in prescribing nor did it differentially affect the very high or very low prescribers.
The form of feedback evaluated here-mailed, unsolicited, centralised, government sponsored, and based on aggregate data-had no impact on the prescribing levels of general practitioners.
评估关于全科医生处方水平的反馈对其处方行为的影响。
随机对照试验。
澳大利亚农村地区的全科医疗。
在非城市地区执业的2440名全职认可的全科医生。
向参与者发送两组(间隔6个月)关于其两年处方率相对于同行处方率的图形展示。提供了五个主要药物类别的数据,并附带教育通讯。对照组未收到关于其处方的任何信息。
干预前后干预组和对照组五个主要药物类别的处方率、总处方量以及潜在替代处方和医嘱情况。
干预组和对照组具有相似的基线特征(年龄、性别、患者构成、执业情况)。干预前后两组的处方率中位数几乎相同。干预组观察到的处方变化在对照组中也有出现。没有证据表明反馈降低了处方的变异性,也没有对处方量极高或极低的医生产生不同影响。
此处评估的反馈形式——邮寄、主动提供、集中、政府资助且基于汇总数据——对全科医生的处方水平没有影响。