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Qual Health Care. Sep 2000; 9(3): 159–165.
PMCID: PMC1743532

Improving doctors' prescribing behaviour through reflection on guidelines and prescription feedback: a randomised controlled study


Background—It is difficult to put research findings into clinical practice by either guidelines or prescription feedback.

Aim—To study the effect on the quality of prescribing by a combined intervention of providing individual feedback and deriving quality criteria using guideline recommendations in peer review groups.

Methods—199 general practitioners in 32 groups were randomised to participate in peer review meetings related to either asthma or urinary tract infections. The dispensing by the participating doctors of antiasthmatic drugs and antibiotics during the year before the intervention period provided the basis for prescription feedback. The intervention feedback was designed to describe the treatment given in relation to recommendations in the national guidelines. In each group the doctors agreed on quality criteria for their own treatment of the corresponding diseases based on these recommendations. Comparison of their prescription feedback with their own quality criteria gave each doctor the proportion of acceptable and unacceptable treatments.

Main outcome measure—Difference in the prescribing behaviour between the year before and the year after the intervention.

Results—Before intervention the mean proportions of acceptably treated asthma patients in the asthma group and urinary tract infection (control) group were 28% and 27%, respectively. The mean proportion of acceptably treated patients in the asthma group was increased by 6% relative to the control group; this difference was statistically significant. The mean proportions of acceptable treatments of urinary tract infection before intervention in the urinary tract infection group and asthma (control) group were 12% for both groups which increased by 13% in the urinary tract infection group relative to the control group. Relative to the mean pre-intervention values this represented an improvement in treatment of 21% in the asthma group and 108% in the urinary tract infection group.

Conclusions—Deriving quality criteria of prescribing by discussing guideline recommendations gave the doctors a basis for judging their treatment of individual patients as acceptable or unacceptable. Presented with feedback on their own prescribing, they learned what they did right and wrong. This provided a foundation for improvement and the process thus instigated resulted in the doctors providing better quality patient care.

Key Words: quality assessment; quality improvement; prescription feedback; continuing medical education; asthma; urinary tract infection

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Selected References

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  • Grol R. Implementing guidelines in general practice care. Qual Health Care. 1992 Sep;1(3):184–191. [PMC free article] [PubMed]
  • Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ. 1998 Aug 15;317(7156):465–468. [PMC free article] [PubMed]
  • Hogerzeil HV. Promoting rational prescribing: an international perspective. Br J Clin Pharmacol. 1995 Jan;39(1):1–6. [PMC free article] [PubMed]
  • Grimshaw JM, Russell IT. Achieving health gain through clinical guidelines II: Ensuring guidelines change medical practice. Qual Health Care. 1994 Mar;3(1):45–52. [PMC free article] [PubMed]
  • Gifford DR, Holloway RG, Frankel MR, Albright CL, Meyerson R, Griggs RC, Vickrey BG. Improving adherence to dementia guidelines through education and opinion leaders. A randomized, controlled trial. Ann Intern Med. 1999 Aug 17;131(4):237–246. [PubMed]
  • O'Connell DL, Henry D, Tomlins R. Randomised controlled trial of effect of feedback on general practitioners' prescribing in Australia. BMJ. 1999 Feb 20;318(7182):507–511. [PMC free article] [PubMed]
  • Kanouse DE, Jacoby I. When does information change practitioners' behavior? Int J Technol Assess Health Care. 1988;4(1):27–33. [PubMed]
  • Spencer JA, Jordan RK. Learner centred approaches in medical education. BMJ. 1999 May 8;318(7193):1280–1283. [PMC free article] [PubMed]
  • Allery LA, Owen PA, Robling MR. Why general practitioners and consultants change their clinical practice: a critical incident study. BMJ. 1997 Mar 22;314(7084):870–874. [PMC free article] [PubMed]
  • Stamm WE, Hooton TM. Management of urinary tract infections in adults. N Engl J Med. 1993 Oct 28;329(18):1328–1334. [PubMed]
  • Aasland OG, Olff M, Falkum E, Schweder T, Ursin H. Health complaints and job stress in Norwegian physicians: the use of an overlapping questionnaire design. Soc Sci Med. 1997 Dec;45(11):1615–1629. [PubMed]
  • Rice N, Leyland A. Multilevel models: applications to health data. J Health Serv Res Policy. 1996 Jul;1(3):154–164. [PubMed]
  • Winkens RA, Pop P, Bugter-Maessen AM, Grol RP, Kester AD, Beusmans GH, Knottnerus JA. Randomised controlled trial of routine individual feedback to improve rationality and reduce numbers of test requests. Lancet. 1995 Feb 25;345(8948):498–502. [PubMed]
  • Curry L, Purkis IE. Validity of self-reports of behavior changes by participants after a CME course. J Med Educ. 1986 Jul;61(7):579–584. [PubMed]
  • Elson RB, Connelly DP. Computerized patient records in primary care. Their role in mediating guideline-driven physician behavior change. Arch Fam Med. 1995 Aug;4(8):698–705. [PubMed]
  • Grol R, Mokkink H, Smits A, van Eijk J, Beek M, Mesker P, Mesker-Niesten J. Work satisfaction of general practitioners and the quality of patient care. Fam Pract. 1985 Sep;2(3):128–135. [PubMed]

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