gms | German Medical Science

10. Jahrestagung der GAA Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

16. bis 17.10.2003, Bonn

Data based pharmacotherapy quality circles in primary care: results from Saxony Anhaltino (SA4), Germany

Datenbasierte Qualitätszirkel zur Pharmakotherapie für Allgemeinmediziner: Resultate aus Sachsen-Anhalt

Meeting Abstract

  • corresponding author Petra Kaufmann-Kolle - AQUA - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Weender Landstr. 11, 37073 Goettingen, Tel.: 0551 / 789 52 - 0, Fax: 0551 / 789 52 - 10
  • B. Broge - AQUA - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Weender Landstr. 11, 37073 Goettingen
  • J. Szecsenyi - AQUA - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Weender Landstr. 11, 37073 Goettingen

Gesellschaft für Arzneimittelanwendungsforschung u. Arzneimittelepidemiologie (GAA) e.V.. 10. Jahrestagung der Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie (GAA) e.V.. Bonn, 16.-17.10.2003. Düsseldorf, Köln: German Medical Science; 2003. Doc03gaa06

The electronic version of this article is the complete one and can be found online at:

Published: October 16, 2003

© 2003 Kaufmann-Kolle et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background and Aim

The escalation of expenses in the german health system has, together with an increased awareness for quality requirements and improvements in efficiency in primary care, led to an increased interest in educational interventions such as feedback reports, small group educations, outreach visits, and quality circles. Quality circles of physicians have been introduced in several regions in Germany, and the impact of these strategies have to be evaluated.

Material and Method

The project described (SA4) has been performed in Saxony-Anhaltino, a federal state of Germany in the years 2000 and 2001, mainly. Physicians were addressed for voluntary participation. The intervention group was derived from 168 practices (178 physicians) organized in 19 groups, so-called quality circles. Physicians were offered a participation in 10 quality circle sessions of about 2 hrs. each. Data were compared to a randomized control group, consisting of about 200 practices from the same region but without any intervention. Part of the evaluation was a pre-defined set of indicators on quality as well as on costs. Evaluation of the intervention was made on the base of prescription data for another three-month period (after finishing the intervention), one year later

Throughout the quality circle intervention several additional instruments were used:

Before each session participants received an individual feedback report based on a detailed analysis of all prescriptions issued by each practice, by the intervention group and by a randomised control group during a three-month period.

In addition, participants received actual background information about the topics discussed.

Sessions were moderated by physicians with special training receiving additional information and materials.


Participation rate was high (average 80% per each meeting). The project was well accepted. High satisfaction with the project in general was found [mean 1.5 on a scale of 1 (= very good) to 6 (= very bad)]. The intervention was assessed as very helpful, relevant and essential (mean 1.8) by the physicians. Both groups showed increasing prescription costs. However, in the intervention group (+10.8%) the increase of prescription costs was much lower than the increase in the control group (+14.9%). In addition, generic drugs were used more often in the intervention group than in the control group. Inspite of this, some of the choosen indicators showed significant improvement in therapeutic quality in the intervention group: e.g. reduction of polymedication (p = 0.045), increased use of recommended antihypertensive drugs (p = 0.022) and recommended antihyperglycemic agents (p = 0.022), respectively. Particularly, quality circles have been shown to be consistently effective in improving the quality and efficiency of the prescription behaviour of the physicians involved.


This study aimed to determine the impact of a large-scale quality circle programme in primary care. Indicators for assessing the quality and costs of prescribing were developed at the AQUA institute, based on research literature and consensus among pharmacists, general practitioners and quality improvement experts. The intervention is characterized by high frequency of attention, high acceptance, lower increase of prescription costs (relative to the control group) and, as shown by several indicators, improved therapeutic quality.