title: The effect of pharmacotherapy audit meetings on early new drug prescribing by general practitioners.
abstract: BACKGROUND
  New drugs are cornerstones of clinical practice. However, when included in practice in an erratic fashion, there is valid concern about uncertain risk-benefit for patients and increased healthcare expenditures. In several countries, general practitioners (GPs) and pharmacists work closely together to ensure proper use of new drugs in clinical practice.
  
  
  OBJECTIVE
  To estimate the effect of pharmacotherapy audit meetings (PTAMs) between GPs and community pharmacists on prescribing of newly marketed drugs by GPs.
  
  
  METHODS
  We conducted an observational study of new drug prescribing in a cohort of 103 GPs, working in 59 practices, from 1999 until 2003. The main outcome measures were the decisions to start therapy with a new drug or with an existing older drug from the same therapeutic category within the first 6 months after market introduction. Multilevel modeling was used for analyses.
  
  
  RESULTS
  Overall, in 6.1% of the decisions to start drug therapy, GPs chose the drug that was most recently introduced into the market. The GPs attending low-quality PTAMs made 1861 decisions to start therapy; in 112 (6.0%) of those decisions, a new drug was preferred over an older alternative. GPs participating in high-quality PTAMs preferred a new drug in only 3.4% of the 3138 decisions made. Compared with GPs participating in PTAMs on the highest quality level (level 4), GPS attending level 1 or level 2 PTAMs were more than twice as likely to start therapy with new drugs than with older drugs (OR 2.24; 95% CI 1.04 to 4.81 vs OR 2.31; 95% CI 1.30 to 4.09, respectively).
  
  
  CONCLUSIONS
  PTAMs may be an effective way to control early prescribing of new drugs in general practice. For PTAMs to be effective, it is vital that GPs and pharmacists set common goals on how to optimize pharmacotherapy. This concordance should be reflected in PTAMs that result in concrete decisions with auditing of GP prescribing behavior. Pharmacists should play an active role in organizing PTAMs to increase their influence on drug prescribing.
authors.affiliation: Faculty of Science, Division of Pharmacoepidemiology & Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.
authors.forename: Stefan R
authors.initials: SR
authors.lastname: Florentinus
authors.forename: Rolf
authors.initials: R
authors.lastname: van Hulten
authors.forename: Marjolein E M
authors.initials: ME
authors.lastname: Kloth
authors.forename: Eibert R
authors.initials: ER
authors.lastname: Heerdink
authors.forename: A M G Fabiënne
authors.initials: AM
authors.lastname: Griens
authors.forename: Hubert G M
authors.initials: HG
authors.lastname: Leufkens
authors.forename: Peter P
authors.initials: PP
authors.lastname: Groenewegen
mesh_terms: D004059:Diffusion of Innovation; D011307:Drug Prescriptions / Q000592:standards; D004358:Drug Therapy / Q000379:methods*; D017723:Drug Utilization Review / Q000639:trends*; D008485:Medical Audit / Q000379:methods*; D009426:Netherlands; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'