gms | German Medical Science

11. Jahrestagung 2004 der GAA

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

30.09. bis 01.10.2004, Jena

Pharmacotherapeutic quality circles: feedback reports and quality indicators from routine data of a great sick-fund for 612 general practitioners in Hesse

Meeting Abstract

  • corresponding author presenting/speaker P. Kaufmann-Kolle - AQUA-Institut fuer angewandte Qualitaetsfoerderung und Forschung im Gesundheitswesen, Goettingen
  • B. Riens - AQUA-Institut fuer angewandte Qualitaetsfoerderung und Forschung im Gesundheitswesen, Goettingen
  • B. Gruen - AQUA-Institut fuer angewandte Qualitaetsfoerderung und Forschung im Gesundheitswesen, Goettingen
  • B. Broge - AQUA-Institut fuer angewandte Qualitaetsfoerderung und Forschung im Gesundheitswesen, Goettingen
  • J. Szecsenyi - AQUA-Institut fuer angewandte Qualitaetsfoerderung und Forschung im Gesundheitswesen, Goettingen; Dept. of General Practice and Health Services Research, University of Heidelberg

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie (GAA) e.V.. 11. Jahrestagung der Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie (GAA) e.V.. Jena, 30.09.-01.10.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04gaa29

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/gaa2004/04gaa29.shtml

Veröffentlicht: 30. September 2004

© 2004 Kaufmann-Kolle et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Context

Since the late eighties, in Germany several health related laws established recommendations and rules with the explicit aim to stimulate quality assurance programms in primary care. Meanwhile, quality circles (QC) are generally considered to be an important tool for quality improvement in primary health care. This is especially the case in Hesse, where the Association of Sickness Fund Physicians (KV Hessen) and the VdAK/AEV Sick Fund support this approach for almost 10 years now.

Aim

To increase a more rational prescribing behavior. To develop and implement indicators for rational prescribing and risk reduction.

Material and Methods

In Hesse, 612 general practitioners (GP) in 57 QC groups participated in the project from June 2002 to May 2003. Participants were provided with individual databased and practice comparison feedback reports which also contain information about appropriate therapeutic recommendations for common diseases such as hypertension, diabetes mellitus etc. Special training courses and supervisions were provided for quality circle moderators to facilitate discussions in the QCs. After the intervention, the extent of the influence on prescribing behaviour was quantified by prescribing indicators. The acceptance of the intervention is quantified by detailed protocols and questionnaires.

Results

Both groups showed increasing prescription costs. However, using more generic drugs in the intervention group the increase of prescription costs (+2.2 %) was lower than the increase in the control group (+3.8 %). Some of the choosen indicators showed significant improvement in therapeutic quality in the intervention group: e.g. reduction of unreasonable drugs (p = 0.000) and drug combinations (p = 0.028), however, increased use of recommended medication such as certain antibiotic drugs (p = 0.000), antihyperglycemic agents (p = 0.005) and lipid lowering drugs (p = 0.035), respectively. The intervention was assessed as very helpful, relevant and essential (mean 2.0 on a six point scale) by the physicians.

Conclusions

Deriving quality criteria from routine prescribing data provided a foundation for improvement. The process resulted in a more rational prescribing: Increased generic prescribing, more use of therapeutically equivalent cheaper drug alternatives and avoiding drugs of limited clinical value. Changes occur slowly but voluntary participation, individual feed back reports and regular structurated meetings are suitable and well accepted tools to improve the GP´s prescribing practice.