Effectiveness of the Combination of Feedback and Educational Recommendations for Improving Drug Prescription in General Practice

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Abstract
Although there is a great concern regarding rational use of drugs, the available evidence for the most appropriate strategies to improve prescribing is scarce.The goal of this study was to evaluate the effectiveness of the combination of feedback of individualized prescribing data and educational recommendations for improving the quality of prescribing in general practice.A quasiexperimental intervention study was conducted in which prescribing rates of 282 family physicians before and after the intervention were compared. Physicians assigned to the individualized feedback group (n = 195) received individual instruction with specific recommendations for improvement according to their baseline prescribing quality levels, whereas physicians in the minimal intervention group (n = 87) only received standard nonindividualized prescribing data for the practice group as a whole.A trend toward increasing high pharmacologic intrinsic value in both groups was observed. Overprescription of antibiotics showed a decrease in the individualized feedback group (P = 0.006) and it did not change in the minimal intervention group. A different trend in the values in each group was observed with nonsteroidal antiinflammatory drugs, although it was not statistically significant. Overprescription of antiulcerative agents decreased among physicians in the individualized feedback group (P = 0.003); however, there were not statistically significant differences as compared with the minimal intervention group. Changes in indicators of drug selection were more favorable for the group with individualized feedback, although no statistically significant differences were observed. Pharmaceutical expenditure increased significantly in the minimal intervention group as compared with the individualized feedback group, with an approximate difference of dollars 7.87 per inhabitant and trimester (P = 0.003).The intervention showed that improving the quality of prescribing was feasible, particularly in overprescribing, and was associated with considerable savings in pharmaceutical costs.