EFFECTIVENESS AND COST OF DIFFERENT STRATEGIES FOR INFORMATION FEEDBACK IN GENERAL-PRACTICE

Aim. The aim of this study was to determine the effectiveness and rela tive cost of three forms of information feedback to general practices - graphical, graphical plus a visit by a medical facilitator and tabul ar. Method. Routinely collected, centrally-held data were used where p ossible, analysed at practice level. Some non-routine practice data in the form of risk factor recording in medical notes, for example weigh t, smoking status, alcohol consumption and blood pressure, were also p rovided to those who requested it. The 52 participating practices were stratified and randomly allocated to one of the three feedback groups . The cost of providing each type of feedback was determined. The imme diate response of practitioners to the form of feedback (acceptability ), ease of understanding (intelligibility), and usefulness of regular feedback was recorded. Changes introduced as a result of feedback were assessed by questionnaire shortly after feedback, and 12 months later . Changes at the practice level in selected indicators were also asses sed 12 and 24 months after initial feedback. Results. The resulting co st per effect was calculated to be 46.10 Pound for both graphical and tabular feedback, 132.50 Pound for graphical feedback plus facilitator visit and 773.00 Pound for the manual audit of risk factors recorded in the practice notes. The three forms of feedback did not differ in i ntelligibility or usefulness, but feedback plus a medical facilitator visit was significantly less acceptable. There was a high level of sel f-reported organizational change following feedback, with 69% of pract ices reporting changes as a direct result; this was not significantly different for the three types of feedback. There were no significant c hanges in the selected indicators at 12 or 24 months following feedbac k. The practice characteristic most closely related to better indicato rs of preventive practice was practice size, smaller practices perform ing significantly better. Separate clinics were not associated with be tter preventive practice. Conclusion. It is concluded that feedback st rategies using graphical and tabular comparative data are equally cost -effective in general practice with about two thirds of practices repo rting organizational change as a consequence; feedback involving unsol icited medical facilitator visits is less cost-effective. The cost-eff ectiveness of manual risk factor audit is also called into question.