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Promoting Rational Drug Prescribing in General Practice
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. (Allmänmedicin)
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 [en]
rational drug prescribing, family medicine, general practice, postal feedback, outreach visits, randomised controlled trial
National Category
Clinical Medicine
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:uu:diva-192315ISBN: 978-91-554-8582-5 (print)OAI: oai:DiVA.org:uu-192315DiVA: diva2:589380
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
List of papers
1. Effect of mailed feedback on drug prescribing profiles in general practice: a seven-year longitudinal study in Storstrom County, Denmark
Open this publication in new window or tab >>Effect of mailed feedback on drug prescribing profiles in general practice: a seven-year longitudinal study in Storstrom County, Denmark
2010 (English)In: Upsala 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.

Keyword
Drug prescribing, general practice, mailed feedback
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-133709 (URN)10.3109/03009734.2010.487165 (DOI)000283555900003 ()
Available from: 2010-11-18 Created: 2010-11-15 Last updated: 2017-12-12Bibliographically approved
2. General practitioners' awareness of their own drug prescribing profiles after postal feedback and outreach visits
Open this publication in new window or tab >>General practitioners' awareness of their own drug prescribing profiles after postal feedback and outreach visits
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.

Keyword
General practice, Mailed feedback, Outreach visits, Prescribing profile
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-186681 (URN)10.3109/03009734.2012.713038 (DOI)000310372800012 ()
Available from: 2012-11-29 Created: 2012-11-29 Last updated: 2017-12-07Bibliographically approved
3. Reducing the prescribing of antibiotics in general practices through outreach visits.: A randomised controlled trial in southern Denmark
Open this publication in new window or tab >>Reducing the prescribing of antibiotics in general practices through outreach visits.: A randomised controlled trial in southern Denmark
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aims: To study the effects of outreach visits and a simple desk guide on the prescribing in general practice of all antibacterial agents intended for systemic use (ATC code J01), broad spectrum penicillins (J01CA), pivmecillinam (J01CA08), and macrolids (J01FA), and betalaktamase sensitive penicillin (J01CE) to expected to be unchanged or increase.

Study population: Eighty-eight out of 94 general practices in the former Storstrøm County, that agreed to participate, were randomly allocated into two parallel study arms, an intervention and a control area.

Method: The year 1999 was used as the run-in-period, 2000 as the intervention period, and the spring of 2001 as the post-trial period. All participating practices received an outreach visit during the intervention period, and focus in the intervention area was on the prescribing of antibacterial agents. Data on practice characteristics and on prescribing level for the six drug groups was obtained from the County Health Insurance database. Multiple linear regression analysis was used to evaluate differences in prescribing trends across the study period.

Results: After adjustments for differences in initial prescribing levels practices in the intervention area prescribed less of all antibacterial agents intended for systemic use and less broad spectrum penicillin than practices in the control area. For the other drug groups under study, pivmecillinam, betalaktamase sensitive penicillins and macrolids, there were non-significant trends in the intended direction.

Conclusions: Outreach visits and a simple desk guide appear to affect the prescribing of antibacterial agents as intended.

Keyword
outreach visits, prescribing, antibiotics, general practice, RTC
National Category
Medical and Health Sciences
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-192311 (URN)
Note

Submitted

Available from: 2013-01-17 Created: 2013-01-17 Last updated: 2013-02-14
4. Effect of outreach visits on the prescribing of non-steroid anti-inflammatory drugs in general practice: A randomised controlled trial in southern Denmark
Open this publication in new window or tab >>Effect of outreach visits on the prescribing of non-steroid anti-inflammatory drugs in general practice: A randomised controlled trial in southern Denmark
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aims: To study the effects of outreach visits and a simple desk guide on the prescribing in general practice of non-steroid anti-inflammatory drugs (ATC code M01A), and its subgroups acetic acid derivatives (ATC code M01AB), oxicames (M01AC), propionic acid derivatives (M01AE), coxibes (M01AH), and other non-steroid anti-inflammatory drugs (M01AX), all expected to decrease.

Study population: 88 out of 94 general practices in the former Storstrøm County, accepting participation, were randomly allocated to an intervention or a control area.

Method: The year 1999 was used as a run-in-period, the year 2000 as an intervention period. All participating practices had an outreach visit during the run-in period, in the intervention area focussed on non-steroid anti-inflammatory drugs. Data on practice characteristics and on prescribing level for the six drug groups was obtained from the County Health Insurance database. Multiple linear regression analysis was used to evaluate differences in prescribing trends across the study period.

Results: After adjustments for differences in initial prescribing levels between the practices in the intervention and the control area no significant differences between the areas in prescribing volume of all non-steroid anti-inflammatory drugs. Neither were any significant differences seen for any of the non-steroid anti-inflammatory drug subgroups.

Conclusions: Contrary to expectations outreach visits and a simple desk guide did not seem to influence the prescribing of non-steroid anti-inflammatory drugs.

Keyword
outreach visits, prescribing, NSAID, general practice, RCT
National Category
Basic Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-192314 (URN)
Note

Manuscript

Available from: 2013-01-17 Created: 2013-01-17 Last updated: 2013-02-14

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