The efficacy of an automated feedback system for general practitioners.
OBJECTIVE
An automated feedback system that produces comments about the non-adherence of general practitioners (GPs) to accepted practice guidelines for ordering diagnostic tests was developed. Before implementing the automated feedback system in daily practice, we assessed the potential effect of the system on the test ordering behaviour of GPs.


METHODS
We used a randomised controlled trial with balanced block design.


METHODS
Five times six participant groups of GPs in a computer laboratory setting.


METHODS
The GPs reviewed a random sample of 30 request forms they filled in earlier that year. If deemed necessary, they could make changes in the tests requested. Next, the system displayed critical comments about their non-adherence to the guidelines as apparent from the (updated) request forms.


METHODS
Twenty-four randomly selected GPs participated.


METHODS
The number of requested diagnostic tests (17% with 95% confidence interval [CI]: 12-22%) and the fraction of tests ordered that were not in accordance with the practice guidelines (39% with 95% CI: 28-51%) decreased due to the comments of the automated feedback system. The GPs accepted 362 (50%) of the 729 reminders.


CONCLUSIONS
Although our experiment cannot predict the size of the actual effect of the automated feedback system in daily practice, the observed effect may be seen as the maximum achievable.
Department of Medical Informatics, Maastricht University, The Netherlands. r.bindels@mi.unimaas.nl
Rianne
R
Bindels
Arie
A
Hasman
Arnold D
AD
Kester
Jan L
JL
Talmon
Paul A
PA
De Clercq
Ron A G
RA
Winkens
D020000:Decision Support Systems, Clinical; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*; D017010:Reminder Systems