Randomised controlled trial of effect of feedback on general practitioners' prescribing in Australia

BMJ 1999;318:507-511 ( 20 February )

General Practice

Randomised controlled trial of effect of feedback on general practitioners' prescribing in Australia

Dianne L O'Connell, senior Brawn fellow, ^a David Henry, professor of clinical pharmacology, ^a Ron Tomlins, senior medical adviser. ^b

^a Discipline of Clinical Pharmacology, Faculty of Medicine and Health Sciences, University of Newcastle, New South Wales, Australia, ^b Professional Review Division, Health Insurance Commission, Tuggeranong, Australian Capital Territory, Australia

Correspondence to: Dr D L O'Connell, Discipline of Clinical Pharmacology, Level 5, Clinical Sciences Building, Newcastle Mater Hospital, Waratah NSW 2298, Australia doconnel{at}mail.newcastle.edu.au

Objective: To evaluate the effect on general practitioners'prescribing of feedback on their levels ofprescribing.
Design: Randomised controlledtrial.
Setting: General practice in ruralAustralia.
Participants: 2440 full time recognised general practitionerspractising in non-urbanareas.
Intervention: Two sets of graphical displays (6 months apart)of their prescribing rates for 2 years, relative to those of theirpeers, were posted to participants. Data were provided for fivemain drug groups and were accompanied by educational newsletters.The control group received no information on theirprescribing.
Main outcome measures: Prescribing rates in the intervention andcontrol groups for the five main drug groups, total prescribingand potential substitute prescribing and ordering before and aftertheinterventions.
Results: The intervention and control groups had similarbaseline characteristics (age, sex, patient mix, practices). Medianprescribing rates for the two groups were almost identical beforeand after the interventions. Any changes in prescribing observedin the intervention group were also seen in the control group.There was no evidence that feedback reduced the variability inprescribing nor did it differentially affect the very high orvery lowprescribers.
Conclusions: The form of feedback evaluated here $---$ mailed,unsolicited, centralised, government sponsored, and based on aggregatedata $---$ had no impact on the prescribing levels of generalpractitioners.

Key messages

Feedback of prescribing data to general practitioners is widely practised by government agencies
The belief is that this will lead to reduced variability and lower rates of prescribing of key drugs, but this has not been tested in randomised trials
In a large randomised trial Australian general practitioners received feedback comprising simple graphical displays of their prescribing data for five key groups of drugs
This had no impact on the level or variability of subsequent prescribing rates
Unsolicited, centralised, government sponsored feedback based on aggregate data had no impact on the prescribing levels of general practitioners

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