Randomised controlled trial of the effectiveness of feedback in improving test ordering in general practice

Baker, Richard C.; Smith, James Falconer; Lambert, Paul C.

doi:10.1080/02813430310002995

Cited by 28 publications

(44 citation statements)

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“…Audit and feedback have often been used and showed mostly a modest effect in terms of influencing test ordering or prescribing. The effect of audit and feedback on adherence to desired practice ranged from -10% to +68% (median +16%) [ 8 - 12 ]. In other studies, the introduction of a problem-based test ordering form proved to be a promising tool to improve test ordering [ 7 , 13 - 18 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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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?

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Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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“…22 Not all previous studies have been positive; Baker et al attributed failure to the short duration of feedback. 23 We believe that our strategy combining A&F, an incentive mechanism and education was benefi cial. A previous study has shown that a multiple strategy approach boosts the effect of A&F. 24 The infl uence of positive feedback (incentive) serves as another major contributing factor in the acceptance and success of A&F intervention in the current study.…”

Section: Mrd 3 Months After the Interventionmentioning

confidence: 92%

Effect of Reinforced Audit and Feedback Intervention on Physician Behaviour: A Multifaceted Strategy for Targeting Medical Record Documentation

Meidani

Farzandipour²,

Davoodabadi³

et al. 2017

Journal of the Royal College of Physicians of Edinburgh

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We investigated the effects of reinforced audit and feedback on the medical record documentation (MRD) of 35 surgical residents at a tertiary university hospital. In three phases (pre-intervention, 3 and 9-month post-intervention), 525 medical records were assessed. An educational guideline assisting residents to record more accurate MRD was developed. The MRD rate in the pre-intervention and immediate post-intervention phases had changed significantly. The MRD rate in the pre-intervention and 9 months after cessation of intervention was not statistically significant. Reinforced audit and feedback had only a short term effect on MRD. To achieve long lasting change, we suggest residents' MRD behaviour must be integrated in their periodic clinical performance evaluation and reinforced through positive feedback including incentive mechanisms.

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“…Baker believed that A&F of limited duration led to failure. 35 We believe that our A&F intervention was successful as we designed a behaviour-based intervention approach based on contributing factors identifi ed in our pilot study of clinicians' viewpoints.…”

Section: Discussionmentioning

confidence: 99%

Going beyond Audit and Feedback: Towards Behaviour-Based Interventions to Change Physician Laboratory Test Ordering Behaviour

Meidani

Ga²,

Kheirkhah

et al. 2017

Journal of the Royal College of Physicians of Edinburgh

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Studies indicate there are a variety of contributing factors affecting physician test ordering behaviour. Identifying these behaviours allows development of behaviour-based interventions.Methods Through a pilot study, the list of contributing factors in laboratory tests ordering, and the most ordered tests, were identi ed, and given to 50 medical students, interns, residents and paediatricians in questionnaire form. The results showed routine tests and peer or supervisor pressure as the most in uential factors affecting physician ordering behaviour. An audit and feedback mechanism was selected as an appropriate intervention to improve physician ordering behaviour. The intervention was carried out at two intervals over a three-month period.Findings There was a large reduction in the number of laboratory tests ordered; from 908 before intervention to 389 and 361 after rst and second intervention, respectively. There was a signi cant relationship between audit and feedback and the meaningful reduction of 7 out of 15 laboratory tests including complete blood count (p = 0.002), erythrocyte sedimentation rate (p = 0.01), C-reactive protein (p = 0.01), venous blood gas (p = 0.016), urine analysis (p = 0.005), blood culture (p = 0.045) and stool examination (p = 0.001).Conclusion The audit and feedback intervention, even in short duration, affects physician ordering behaviour. It should be designed in terms of behaviour-based intervention and diagnosis of the contributing factors in physicians' behaviour. Further studies are required to substantiate the effectiveness of such behaviour-based intervention strategies in changing physician behaviour.Keywords: audit and feedback, child, diagnostic tests, laboratory medicine, medical students, physicians, teaching rounds, test ordering, test request, utilisation review Declaration of interests: No confl ict of interests declaredAbstract Introduction

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Randomised controlled trial of the effectiveness of feedback in improving test ordering in general practice

Abstract: Feedback did not have an influence on test ordering by general practitioners in this study. More intensive strategies may be required to change the use of laboratory tests.

Cited by 28 publications

References 1 publication

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

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

Effect of Reinforced Audit and Feedback Intervention on Physician Behaviour: A Multifaceted Strategy for Targeting Medical Record Documentation

Going beyond Audit and Feedback: Towards Behaviour-Based Interventions to Change Physician Laboratory Test Ordering Behaviour

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