مقاله انگلیسی رایگان در مورد بازخورد با بررسی همسان در نسخه نویسی پزشکان عمومی – NCBI 2017

Spiralling healthcare costs are a major concern for policymakers worldwide. Overuse, underuse and misuse of healthcare are estimated to be responsible for 30% of the total spending on healthcare annually. It has been estimated that 7% of the wasted healthcare spending in the US is due to overtreatment, including test ordering and prescribing [1]. In the years 2004–2011, the average annual growth in the number of prescriptions in the Netherlands was 5.7%; in fact, the growth of the national income of the Netherlands has been smaller than the growth of the healthcare budget year after year [2, 3]. If nothing is done to reduce the growth in healthcare spending, it is feared that Western countries will not be able to pay the healthcare bill in the long term. Therefore, physicians are being targeted by policymakers to contribute on reducing waste in healthcare, and are encouraged to alter their habits. An unsolved problem with changing professional behaviour is the lack of a clear and solid benchmark for the desired behaviour [4, 5]. This can be overcome by using practice variations as a proxy for quality of care. A certain degree of practice variation is clearly warranted, given the unique profiles of individual patients and practice populations. However, when practice variation is caused by underuse or overuse of care, this results in unwarranted variation and thus inappropriate care [6]. In the Netherlands, general practitioners (GPs) now have access to over 100 evidence-based clinical practice guidelines. These guidelines have been developed by the Dutch College of General Practitioners (NHG) with the aim of reducing unwarranted practice variation and improving the quality of care provided. Although the general adherence to these guidelines seems quite reasonable, viz. approximately 70%, there is considerable practice variation in test ordering and prescribing, indicating room for improvement in poorly performing practices [7–12]. In local quality improvement collaboratives (LQICs), general practitioners meet on a regular basis to discuss current issues and gain new insights concerning test ordering and prescribing behaviour. Healthcare organisations and governments promote these meetings as a means to implement guidelines. LQICs are widely implemented in primary care, mainly in Europe and, to a lesser degree, in North America. Local pharmacists are members of these groups and are well respected for their input and knowledge. These LQICs are an attractive target for interventions aimed at changing professional behaviour both effectively and efficaciously [13–20]. In a robust trial on three clinical topics, Verstappen et al. showed the beneficial effects of a multifaceted strategy involving audit and feedback with peer review in LQICs on test ordering behaviour. They found a reduction in the volumes of tests ordered ranging from 8 to 12% for the various clinical topics [21, 22]. Lagerlov et al. showed that individual feedback embedded in local peer group discussions improved appropriate treatment of asthma patients by 21% and urinary tract infections by 108%, compared to baseline values [23]. There is also evidence suggesting that the mere provision of information on test fees when presented at the time of the order entry reduces the volumes of tests ordered [24]. Most of this evidence, however, stems from trials focussing on a single or limited number of clinical topics, and involving a strong influence of the researcher on the participants, e.g. as moderator during sessions. Moreover, in the Verstappen trial, the included groups were selected by the researcher and can be regarded as innovator groups. We wanted to build on the experiences from the work by Verstappen et al. and undertake a large-scale implementation of the strategy in a pragmatic trial with much room for the LQICs to adapt the strategy to their own needs and without any researchers being present embedded within the existing network of LQICs.