Trietsch J, van Steenkiste B, Grol R, Winkens B, Ulenkate H, Metsemakers J, van der Weijden T
School for Public Health and Primary Care (CAPHRI), Department of Family Medicine, Maastricht University, PO Box 616, , 6200 MD, Maastricht, The Netherlands.
IQ Healthcare, Radboud University Nijmegen, PO Box 9101 (144), , 6500HB, Nijmegen, The Netherlands.
BMC Fam Pract. 2017 Apr 13;18(1):53. doi: 10.1186/s12875-017-0605-5.
Much research worldwide is focussed on cost containment and better adherence to guidelines in healthcare. The research focussing on professional behaviour is often performed in a well-controlled research setting. In this study a large-scale implementation of a peer review strategy was tested on both test ordering and prescribing behaviour in primary care in the normal quality improvement setting.
We planned a cluster-RCT in existing local quality improvement collaboratives (LQICs) in primary care. The study ran from January 2008 to January 2011. LQICs were randomly assigned to one of two trial arms, with each arm receiving the same intervention of audit and feedback combined with peer review. Both arms were offered five different clinical topics and acted as blind controls for the other arm. The differences in test ordering rates and prescribing rates between both arms were analysed in an intention-to-treat pre-post analysis and a per-protocol analysis.
Twenty-one LQIC groups, including 197 GPs working in 88 practices, entered the trial. The intention-to-treat analysis did not show a difference in the changes in test ordering or prescribing performance between intervention and control groups. The per-protocol analysis showed positive results for half of the clinical topics. The increase in total tests ordered was 3% in the intervention arm and 15% in the control arm. For prescribing the increase in prescriptions was 20% in the intervention arm and 66% in the control group. It was observed that the groups with the highest baseline test ordering and prescription volumes showed the largest improvements.
Our study shows that the results from earlier work could not be confirmed by our attempt to implement the strategy in the field. We did not see a decrease in the volumes of tests ordered or of the drugs prescribed but were able to show a lesser increase instead. Implementing the peer review with audit and feedback proved to be not feasible in primary care in the Netherlands.
This trial was registered at the Dutch trial register under number ISRCTN40008171 on August 7 2007.
全球范围内的许多研究都聚焦于医疗保健领域的成本控制和更好地遵循指南。关于专业行为的研究通常在控制良好的研究环境中进行。在本研究中，在正常质量改进环境下的初级保健中，对同行评审策略在检查单开具和处方行为方面的大规模实施进行了测试。
我们在现有的初级保健地方质量改进协作组织（LQICs）中计划了一项整群随机对照试验。该研究从2008年1月持续到2011年1月。LQICs被随机分配到两个试验组之一，每组都接受相同的审计与反馈以及同行评审干预。两组都被提供五个不同的临床主题，并作为另一组的盲法对照。在意向性分析的前后分析和符合方案分析中，分析了两组之间检查单开具率和处方率的差异。
21个LQIC组，包括在88家诊所工作的197名全科医生，进入了试验。意向性分析未显示干预组和对照组在检查单开具或处方表现变化方面存在差异。符合方案分析显示，一半的临床主题有积极结果。干预组开具的检查单总数增加了3%，对照组增加了15%。就处方而言，干预组处方增加了20%，对照组增加了66%。观察到基线检查单开具量和处方量最高的组改善最大。
我们的研究表明，我们在该领域实施该策略的尝试未能证实早期研究的结果。我们没有看到检查单开具量或处方药物量的减少，而是能够显示出较小的增加。事实证明，在荷兰的初级保健中，实施带有审计与反馈的同行评审是不可行的。
该试验于2007年8月7日在荷兰试验注册中心注册，注册号为ISRCTN40008171。
