OBJECTIVE: To assess the effectiveness of the pharmacotherapeutic circle (PTC), a general practitioner (GP) prescribing-improvement programme to enhance prescribing quality and reduce drug costs. DESIGN: Combined pre- and post-intervention time-series design using an internal comparison of subgroups and an external comparative control. SETTING: Small discussion groups meeting 8 times over 18 months. PARTICIPANTS: 79 GPs exceeding the mean drug costs/patient of all Hessian physicians by > or = 40%; 10 moderators. INTERVENTIONS: Peer-review feedback of prescription patterns based on guidelines targeting 3 suboptimal prescribing areas: drug prescriptions lacking evidence-based efficacy (target A); presumptive prescribing habits (target B); and underprescribing of new, effective therapies (target C). MAIN OUTCOME MEASURES AND RESULTS: Significant decreases in prescription rates for target A drugs were recorded for varicose vein medications (p = 0.006), peripheral vasodilators (p = 0.0001) and topical antirheumatics (p = 0.0145), but not for prokinetics/enzymes/digestives. Prescribing of target B drugs such as benzodiazepines and nonsteroidal anti-inflammatory drugs declined markedly (p = 0.0019 and 0.0014, respectively). Target C drug prescriptions such as for opioids and proton pump inhibitors were not significantly increased. Highly significant reductions in prescription costs were observed for target A and B drugs, irrespective of whether GPs were stratified into high, medium or low prescribers. When mean prescribing costs for PTC participants were compared with those of a control group comprising 8000 GPs over a 21-month period, PTC GPs decreased their costs by 2%, whereas drug costs for all Hessian physicians rose by 10%. CONCLUSIONS: PTCs appear to be an effective method to optimise the quality of drug prescribing and reduce drug costs.
OBJECTIVE: To assess the effectiveness of the pharmacotherapeutic circle (PTC), a general practitioner (GP) prescribing-improvement programme to enhance prescribing quality and reduce drug costs. DESIGN: Combined pre- and post-intervention time-series design using an internal comparison of subgroups and an external comparative control. SETTING: Small discussion groups meeting 8 times over 18 months. PARTICIPANTS: 79 GPs exceeding the mean drug costs/patient of all Hessian physicians by > or = 40%; 10 moderators. INTERVENTIONS: Peer-review feedback of prescription patterns based on guidelines targeting 3 suboptimal prescribing areas: drug prescriptions lacking evidence-based efficacy (target A); presumptive prescribing habits (target B); and underprescribing of new, effective therapies (target C). MAIN OUTCOME MEASURES AND RESULTS: Significant decreases in prescription rates for target A drugs were recorded for varicose vein medications (p = 0.006), peripheral vasodilators (p = 0.0001) and topical antirheumatics (p = 0.0145), but not for prokinetics/enzymes/digestives. Prescribing of target B drugs such as benzodiazepines and nonsteroidal anti-inflammatory drugs declined markedly (p = 0.0019 and 0.0014, respectively). Target C drug prescriptions such as for opioids and proton pump inhibitors were not significantly increased. Highly significant reductions in prescription costs were observed for target A and B drugs, irrespective of whether GPs were stratified into high, medium or low prescribers. When mean prescribing costs for PTC participants were compared with those of a control group comprising 8000 GPs over a 21-month period, PTC GPs decreased their costs by 2%, whereas drug costs for all Hessian physicians rose by 10%. CONCLUSIONS: PTCs appear to be an effective method to optimise the quality of drug prescribing and reduce drug costs.
Authors: Brian Godman; William Shrank; Morten Andersen; Christian Berg; Iain Bishop; Thomas Burkhardt; Kristina Garuoliene; Harald Herholz; Roberta Joppi; Marija Kalaba; Ott Laius; Julie Lonsdale; Rickard E Malmström; Jaana E Martikainen; Vita Samaluk; Catherine Sermet; Ulrich Schwabe; Inês Teixeira; Lesley Tilson; F Cankat Tulunay; Vera Vlahović-Palčevski; Kamila Wendykowska; Bjorn Wettermark; Corinne Zara; Lars L Gustafsson Journal: Front Pharmacol Date: 2011-01-07 Impact factor: 5.810
Authors: Luísa Sá; Andreia Sofia Costa Teixeira; Fernando Tavares; Cristina Costa-Santos; Luciana Couto; Altamiro Costa-Pereira; Alberto Pinto Hespanhol; Paulo Santos; Carlos Martins Journal: BMJ Open Date: 2017-11-15 Impact factor: 2.692
Authors: Lorette A Stammen; Erik W Driessen; Celine C V I Notermans; Fedde Scheele; Laurents P S Stassen; Renée E Stalmeijer Journal: Acad Med Date: 2020-05 Impact factor: 6.893