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GENERAL PRACTICE: Dianne L O'Connell, David Henry, and Ron Tomlins Randomised controlled trial of effect of feedback on general practitioners' prescribing in Australia BMJ 1999; 318: 507-511 [Abstract] [Full text]

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Alexander Williams   (19 March 1999)

Untitled 19 March 1999
Alexander Williams Send response to journal: Re: this article	Dear Editor In response to the paper by O'Connell et al on the effect of feedback on General Practioners prescribing in Australia [1] I would like to report the effectiveness of prescribing initiatives that have altered our prescribing budget from a 7% overspend for 1998 to a projected underspend of 5% this year. In a partnership of13 with a prescribing budget in excess of £2 million this ammounts to considerable savings. In contrast to the experience of O'Connell we have based our interventions at a practice level and have used a variety of sources of prescribing information. The reasons for our success in achieving such a change in prescribing costs are complex and multifactorial. The recently established Primary Care Groups has made it necessary for practices to control their prescribing costs if they are not to receive shortfalls in budgets elsewhere. With this in mind we [as a partnership] have had several meetings with the prescribing department of our Patient Practitioner Services Authority [PPSA] and highlighted areas of significant overspend.We then circulated partners with individual lists of patients on a given medication with advise to change, if possible, to equivalent but cheaper alternatives. We have had regular feedback at our monthly partnership meeting and produce comparitive data for individual partners prescribing in individual specific areas. This has proved to be quite a powerful force to motivate change. I am aware that change of human behavior can be very difficult,however we have achieved some of our success by trying to approach this in a non confrontational manner, avoiding conflict, interacting at an adult-adult level , using positive feedback and praise wherever possible. Whatever the mechanism it seems to have worked and in stark contrast to, Connell have significantly reduced our prescribing budgets despite actively prescribing statins in the primary and secondary prevention of coronary artery disease. [1] O,Connell DL,Henry D, Tomlins R. Randomised controlled trial of effect of feedback on general practitioners prescribing in Australia. BMJ;318:507-511. Alexander Williams General Practitioner St Thomas Health Centre Cowick St Exeter EX4 1HJ