Trials of providing costing information to general practitioners: a systematic review.
OBJECTIVE
To determine if providing general practitioners (GPs) with costing information can change their clinical behaviour and reduce medical costs.


METHODS
MEDLINE, CINAHL, Health Plan and EMBASE and citations in review articles were searched for studies published between 1980 and 1996.


METHODS
Studies were included if they provided costing information to GPs with the aim of decreasing costs by changing behaviour, included an objective measure of GP performance or clinical care, and used a randomised or quasi-randomised controlled design, crossover design or a controlled time series.


METHODS
Data extracted included study design, intervention used and measure of GP performance/clinical care (including test ordering, drug prescribing, hospital and primary care visits and costs).


RESULTS
Six studies met the inclusion criteria. Computerised feedback on drug costs increased generic prescribing, and "academic detailing" decreased inappropriate prescribing of target drugs. Providing costing information also decreased ordering of diagnostic tests. "Gatekeeper" physicians reduced use of hospital and specialist services. Only two studies found the changes were sustained for nine months or longer and only one evaluated health outcomes.


CONCLUSIONS
The provision of costing information can change GP behaviour in all service areas. Sustainability of these changes and linking of cost savings to health outcomes have not been well studied.
Beilby
J J
JJ
Research and Health Promotion Unit, Royal Australian College of General Practitioners, Adelaide, SA. jbeilby@medicine.adelaide.edu
Silagy
C A
CA
D005194:Family Practice / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D007255:Information Services; D010821:Physicians, Family / Q000191:economics; D010818:Practice Patterns, Physicians'; D016032:Randomized Controlled Trials as Topic; D014481:United States