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Effect of mailed feedback on drug prescribing profiles in general practice: a seven-year longitudinal study in Storstrom County, Denmark
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
2010 (English)In: Uppsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 115, no 4, 238-244 p.Article in journal (Refereed) Published
Abstract [en]

Background. Whether written feedback on drug prescribing in general practice affects prescribing habits is controversial. Most short-term studies showed no effect. However, the issue has not been tested in long-term studies involving the local general practitioner community. Aims of the study. To assess whether prescribing levels in general practice are affected by long-term, unsolicited, systematically repeated, mailed feedback. Methods. Each of the 94 general practices in Storstrom County, Denmark, received semi-annual, mailed feedback about their prescribing volumes and costs within 13 major drug groups, in relation to the levels for all the other 93 practices over a 7-year period in a project initiated by the local general practitioner association. Data on the number of defined daily doses (DDDs) prescribed per 1000 listed patients in each practice per 6-months, and practice characteristics, were obtained from the Pharmaceutical Database at the County Health Department. Results. There was a large variation in drug prescribing volume between practices, but little within-practice variation over time. After adjustments for the influence of practice size and other potential outcome-affecting variables, there was no evidence of a general change of prescribing volume over time, no change among practices with a high or a low prescribing level, and no significant change within the various drug groups. Conclusions. We found no significant effects on prescribing levels of mailed feedback, even when repeated semi-annually during 7 years and initiated by the local general practitioner community.

Place, publisher, year, edition, pages
2010. Vol. 115, no 4, 238-244 p.
Keyword [en]
Drug prescribing, general practice, mailed feedback
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-133709DOI: 10.3109/03009734.2010.487165ISI: 000283555900003OAI: oai:DiVA.org:uu-133709DiVA: diva2:371017
Available from: 2010-11-18 Created: 2010-11-15 Last updated: 2013-02-14Bibliographically approved
In thesis
1. Promoting Rational Drug Prescribing in General Practice
Open this publication in new window or tab >>Promoting Rational Drug Prescribing in General Practice
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims: To introduce the concepts “quality assurance”, “rational drug prescribing” and “outreach visits” in general practice in Storstrøm County, Denmark and study the effect of unsolicited mailed feedback and outreach visits on drug prescribing.

Methods: The first step was to generate standardised charts displaying the county variations of drug volume prescribing within 13 major drug groups at the second ATC-level. The charts were mailed unsolicited to the 94 general practices in the county. Each practice could identify its position within the county prescribing variation. This procedure was repeated every six months from 1992 to 1998. In 1998 annual outreach visit were offered to general practice and 88 of 94 practices accepted. The awareness of prescribing profiles was monitored during the visits in 1998 and 1999. In 2000 a randomised controlled trial allocating practices into two parallel arms was launched. Effects of two desk guides on rational drug prescribing promoted during outreach visits were evaluated.

Results: During the period of mailed feedback, there was a large variation in drug prescribing volumes between practices but little within-practice variation over time. No significant change was detected. Practitioners’ assessment of their own prescribing profiles improved significantly through the outreach visits. The prescribing of antibiotics was significantly affected by the desk guide whereas no effect was detected on the prescribing of non-steroid anti-inflammatory drugs.

Conclusions: Semi-annually mailed feedback over a seven-year period had no significant effect on prescribing volumes or variations in prescribing volumes, but some effect on the practitioners’ awareness of their own prescribing profiles. Outreach visits significantly improved the awareness. A randomised controlled trial using outreach visits combined with a simple desk guide affected the prescribing of some antibacterial drugs as intended whereas the similar intervention had no detectable effect on the prescribing of non-steroid anti-inflammatory drugs.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 64 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 858
Keyword
rational drug prescribing, family medicine, general practice, postal feedback, outreach visits, randomised controlled trial
National Category
Clinical Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-192315 (URN)978-91-554-8582-5 (ISBN)
Public defence
2013-03-01, Rudbeckssalen, Dag Hammarskjölds väg 20, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2013-02-07 Created: 2013-01-17 Last updated: 2013-02-14Bibliographically approved

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