title: Pharmacotherapeutic circles. Results of an 18-month peer-review prescribing-improvement programme for general practitioners.
abstract: 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.
  
  
  METHODS
  Combined pre- and post-intervention time-series design using an internal comparison of subgroups and an external comparative control.
  
  
  METHODS
  Small discussion groups meeting 8 times over 18 months.
  
  
  METHODS
  79 GPs exceeding the mean drug costs/patient of all Hessian physicians by > or = 40%; 10 moderators.
  
  
  METHODS
  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).
  
  
  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.affiliation: Primary Healthcare Research Unit, University of Cologne, Germany. Liselotte.vonFerber@medizin.uni-koeln.de
authors.forename: L
authors.initials: L
authors.lastname: von Ferber
authors.forename: J
authors.initials: J
authors.lastname: Bausch
authors.forename: I
authors.initials: I
authors.lastname: Köster
authors.forename: I
authors.initials: I
authors.lastname: Schubert
authors.forename: P
authors.initials: P
authors.lastname: Ihle
mesh_terms: D003363:Cost Control; D011307:Drug Prescriptions / Q000191:economics / Q000592:standards*; D004358:Drug Therapy / Q000191:economics / Q000592:standards*; D005858:Germany; D006801:Humans; D008332:Management Quality Circles; D010380:Peer Review; D010821:Physicians, Family / Q000191:economics / Q000592:standards*