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General practitioners' awareness of their own drug prescribing profiles after postal feedback and outreach visits
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
2012 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, no 4, 439-444 p.Article in journal (Refereed) Published
Abstract [en]

Background. General practice accounts for the vast majority of drug prescribing in the Nordic countries. Various methods have been used to promote rational drug prescribing. Awareness of own prescribing profile may be a first crucial step in the quality assessment and improvement process. Aim of the study. To analyse awareness among general practitioners of their drug prescribing profile during two outreach visits one year apart. Methods. All 94 practices with a total of 166 general practitioners in the former Storstrom County, Denmark, were invited to participate in a project launching outreach visits led by a general practitioner; 88 practices with 160 general practitioners agreed to participate. Results. During the first round of outreach visits the general practitioners were asked to rate their own prescribing level of 13 major drug groups as being in the lowest 25%, the middle 26%74%, or the highest 25% of the distribution across all 88 practices. The result was better than chance (chi-square 337, 4 df, r 0.37, both P < 0.0001). After the assessment a one-hour discussion on rational drug prescribing was held. One year later a new round of outreach visits was held. This time the assessment accuracy was generally greatly improved (chi-square 724, 4 df, r 0.48, both P < 0.0001). The main determinants for the improved accuracy during the second round were high accuracy during the first round, and the number of general practitioners in the practice. Conclusions. General practitioners' awareness of their prescribing volumes was substantially improved by a single outreach visit with discussion on rational drug prescribing.

Place, publisher, year, edition, pages
2012. Vol. 117, no 4, 439-444 p.
Keyword [en]
General practice, Mailed feedback, Outreach visits, Prescribing profile
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-186681DOI: 10.3109/03009734.2012.713038ISI: 000310372800012OAI: oai:DiVA.org:uu-186681DiVA: diva2:573052
Available from: 2012-11-29 Created: 2012-11-29 Last updated: 2017-12-07Bibliographically 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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Vægter, KeldWahlström, RolfSvärdsudd, Kurt

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