دانلود رایگان مقاله انگلیسی تاثیر حسابرسی و بازخورد با بررسی همسان در نسخه نویسی پزشکان عمومی - NCBI 2017

Abstract

Background: 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. Methods: 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. Results: Twenty-one LQIC groups, including 197 GPs working in 88 practices, entered the trial. The intentionto-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. Conclusions: 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. Trial Registration: This trial was registered at the Dutch trial register under number ISRCTN40008171 on August 7th 2007.

Conclusions

Our intervention, which aimed at changing the test ordering and prescribing behaviour of GPs by means of auditing and feedback, embedded in LQICs, with academia at a distance, shows that the favourable results of earlier work could not be replicated. It appeared that large-scale uptake of evidence-based but complex implementation strategies with a minimum of influence of external researchers, but with the stakeholders in healthcare themselves being responsible for the work that comes with integrating this intervention into their own groups, was not feasible. Although our study suffered from a lack of power, we expect that even if a sufficient number of groups had been included, no clinically relevant changes would have been observed.