A cluster randomized controlled trial aimed at implementation of local quality improvement collaboratives to improve prescribing and test ordering performance of general practitioners: Study Protocol

Abstract

Background: The use of guidelines in general practice is not optimal. Although evidence-based methods to improve guideline adherence are available, variation in physician adherence to general practice guidelines remains relatively high. The objective for this study is to transfer a quality improvement strategy based on audit, feedback, educational materials, and peer group discussion moderated by local opinion leaders to the field. The research questions are: is the multifaceted strategy implemented on a large scale as planned?; what is the effect on general practitioners' (GPs) test ordering and prescribing behaviour?; and what are the costs of implementing the strategy?

Influence of multiple initiatives in Sweden to enhance ARB prescribing efficiency following generic losartan; findings and implications for other countries

“…These various findings substantiate the observation that there is no transfer of physician prescribing behaviour from one class to another even if the classes are closely related as on this occasion with ACEIs and ARBs, i.e. no Hawthorne effect . Consequently, multiple interventions are needed to change physician prescribing behaviour.…”

Are specific initiatives required to enhance prescribing of generic atypical antipsychotics in Scotland?: International implications

“…This may well reflect the advice from NICE and the conclusions of the various Cochrane reviews and CATIE studies that treatments should be tailored to the individual as schizophrenia and bipolar disease are far more complex to treat than diseases treated with the PPIs, statins, ACEIs or ARBs. Consequently, there is no apparent Hawthorne effect . However, this will need further research before any definite conclusions can be drawn especially with the growing utilisation of the patented atypical antipsychotic drugs (quetiapine and aripiprazole) during the study period, reduced utilisation of risperidone as a percentage of atypical antipsychotic drugs (Figures and ), and substantial fines for Johnson and Johnson and AstraZeneca for their marketing activities .…”

“…This builds on general initiatives in Scotland to enhance the prescribing of generics, e.g. a Hawthorne effect , especially as olanzapine and quetiapine were among the ten highest expenditure drugs in Scotland in 2010 .…”

Potential to Enhance the Prescribing of Generic Drugs in Patients with Mental Health Problems in Austria; Implications for the Future

“…As a result, there is again a need for specific demand-side measures to change subsequent prescribing habits with greater individualization of treatment (Brkicic et al, 2012). Consequently, authorities cannot rely on a Hawthorne effect between classes (Holden, 2001; Verstappen et al, 2004; Trietsch et al, 2009; Konstantinou, 2012) especially for complex disease areas. The Hawthorne effect in studies relates to the confounding that occurs if experimenters fail to realize how the consequences of a given subject’s performance in one area may affect activities in another area (Parsons, 1974).…”

“…Again this is unlike the situation with the PPIs, statins or renin-angiotensin inhibitor drugs, with schizophrenia and bipolar diseases seen as more complex to treat than acid-related stomach disorders, hypercholesterolemia or hypertension. Consequently, again no Hawthorne effect transferring initiatives from other disease areas to schizophrenia or bipolar disease (Holden, 2001; Verstappen et al, 2004; Trietsch et al, 2009; Konstantinou, 2012). The lack of a Hawthorne effect is no doubt enhanced in this situation by lack of any desire among physicians to switch patients between atypical antipsychotic drugs when they are stable on a particular one.…”