title: A study of adherence to drug recommendations by providing feedback of outpatient prescribing patterns to hospital specialists.
abstract: OBJECTIVE
  To study the effect of feedback using prescribing profiles combined with interactive group discussions on hospital specialists' adherence to evidence-based guidelines for drug treatment of common diseases issued by a regional Drug and Therapeutics Committee.
  
  
  METHODS
  Intervention study performed at 17 clinics at a university hospital in a Swedish metropolitan health region with comparative clinics at a second university hospital as a control. Prescribing profiles based on aggregate pharmacy dispensing data were presented for the physicians in interactive group discussions. Deviations from the guidelines were discussed at each clinic and specific goals of improvement were formulated. The effect was assessed by pre- and post-intervention comparison of the adherence to guidelines for all drugs and within 11 selected therapeutic areas. The credibility and usefulness of the prescribing profiles were evaluated by a questionnaire.
  
  
  RESULTS
  The adherence to pharmaceutical products within the pharmacological groups stated in the guideline increased by 2.8%-units at the intervention hospital compared with 0.8%-units at the control hospital. The adherence to drug substance increased by 0.4%-units at the intervention hospital while it decreased by 1.8%-units at the control hospital. For 8 of 11 pre-defined specific goals of improvement, the change in adherence was more positive at the intervention hospital. Most doctors considered the feedback provided clear and relevant.
  
  
  CONCLUSIONS
  Interactive group discussions with prescribing profiles were found to be useful in improving hospital specialists' adherence to guidelines. However, the effect on the overall adherence was modest, indicating the importance of clear messages for improvement and relevant guidelines for the prescribing of specialist drugs but also more precise methods for evaluating the effect of real-life-interventions.
authors.affiliation: Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, WHO Collaborating Centre for Drug Utilization Research and Clinical Pharmacological Services, Huddinge, Stockholm, Sweden. bjorn.wettermark@apoteket.se
authors.forename: Björn
authors.initials: B
authors.lastname: Wettermark
authors.forename: Kjell
authors.initials: K
authors.lastname: Haglund
authors.forename: Lars L
authors.initials: LL
authors.lastname: Gustafsson
authors.forename: Peter M
authors.initials: PM
authors.lastname: Persson
authors.forename: Ulf
authors.initials: U
authors.lastname: Bergman
mesh_terms: D001291:Attitude of Health Personnel; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000592:standards*; D004496:Education, Continuing; D005246:Feedback; D017408:Guidelines as Topic; D006761:Hospitals; D006801:Humans; D020407:Internet; D010045:Outpatients; D010595:Pharmacists; D010606:Pharmacy and Therapeutics Committee; D010820:Physicians; D010821:Physicians, Family; D012042:Registries; D013548:Sweden; D013810:Therapeutic Equivalency