Quality circles to improve prescribing of primary care physicians. Three comparative studies

Abstract

Quality circles had a modest effect on prescribing quality and costs. If widely implemented, they could have nationwide impact on the quality and costs of prescribing in primary care.

Impacto de intervenções para promoção do uso de medicamentos genéricos: revisão sistemática

“…The selected designs were two RCTs, five NRCTs, seven CBAs and three ITS. The interventions were found to be educational 3,[16][17][18]25,26,[30][31][32]35 , of financial incentive 4,32,36,37 , electronic prescription 38,39 and managerial 40 . The main characteristics of the studies are summarized in Chart 1.…”

“…Intervention affecting the prescriber's behavior Among educational interventions, most aimed at changing the prescriber's behavior in relation to increased prescription of generic drugs 3,17,18,25,26,[31][32] or reduced prescription by the reference name 16 . These interventions showed small to average increase in generic prescription and average reduction in the prescription by the reference name, but the quality of evidence of these studies was very low (Chart 3).…”

“…Among educational interventions focused on increasing generic prescriptions, Wensing et al 18 held periodic meetings with small groups of 8 to 14 prescribers to report generic prescription rates and feedback on good prescribing practices. The intervention group showed a prescription increase of 0.75% (95% CI: 0.40-1.10) of the increase obtained in the control group.…”

“…These studies 3,[16][17][18]25,26,[30][31][32] showed small to medium impact, always favorable to generic prescription, but with very low quality evidence (Chartes 2 and 3).…”

“…Most of the interventions observed in the literature focus on the physician's behavioral change regarding its prescription 16,17 to improve its quality and promote the rational use of medicines 18 . Dunne & Dunne 19 conducted a review of observational and qualitative studies on the knowledge, acceptance and use of generic drugs from the perspective of physicians, pharmacists and consumers, showing the importance of information and knowledge about the equivalence of generic drugs, but without evaluating the interventions used to improve their prospects and broaden their use.…”