Pharmacotherapeutic circles results of an 18-month peer-review prescribing-improvement programme for general practitioners

Objective: To assess the effectiveness of the pharmacotherapeutic circle (P TC), a general practitioner (GP) prescribing-improvement programme to enhan ce prescribing quality and reduce drug costs. Design: Combined pre- and post-intervention time-series design using an int ernal comparison of subgroups and an external comparative control. Setting: Small discussion groups meeting 8 times over 18 months. Participants: 79 GPs exceeding the mean drug costs/patient of all Hessian p hysicians by greater than or equal to 40%; 10 moderators. Interventions: Peer-review feedback of prescription patterns based on guide lines 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). Main outcome measures and results: Significant decreases in prescription ra tes for target A drugs were recorded for varicose vein medications (p = 0.0 06), 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 dec lined markedly (p = 0.0019 and 0.0014, respectively). Target C drug prescri ptions such as for opioids and proton pump inhibitors were not significantl y increased. Highly significant reductions in prescription costs were obser ved for target A and B drugs, irrespective of whether GPs were stratified i nto high, medium or low prescribers. When mean prescribing costs for PTC pa rticipants 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 c osts 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.