TRIALS OF PROVIDING COSTING INFORMATION TO GENERAL-PRACTITIONERS - A SYSTEMATIC REVIEW

Objective: To determine if providing general practitioners (GPs) with costing information can change their clinical behaviour and reduce med ical costs. Data sources: MEDLINE, CINAHL, Health Plan and EMBASE and citations in review articles were searched for studies published betwe en 1980 and 1996. Study selection: Studies were included if they provi ded costing information to GPs with the aim of decreasing costs by cha nging behaviour, included an objective measure of GP performance or cl inical care, and used a randomised or quasi-randomised controlled desi gn, crossover design or a controlled time series. Data extraction: Dat a extracted included study design, intervention used and measure of GP performance/clinical care (including test ordering, drug prescribing, hospital and primary care visits and costs). Data synthesis: Six stud ies met the inclusion criteria. Computerised feedback on drug costs in creased generic prescribing, and ''academic detailing'' decreased inap propriate prescribing of target drugs. Providing costing information a lso decreased ordering of diagnostic tests. ''Gatekeeper'' physicians reduced use of hospital and specialist services. Only two studies foun d the changes were sustained for nine months or longer and only one ev aluated health outcomes.Conclusion: The provision of costing informati on can change GP behaviour in all service areas. Sustainability of the se changes and linking of cost savings to health outcomes have not bee n well studied.