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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
Re: Randomised controlled trial of effect of feedback on general practitioners' prescribing in Australia
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
Competing interests: No competing interests