The realization of multifactorial interventions involving professionals from both levels of care could be an effective strategy to improve the use of antimicrobials in primary care.

This study shows better compliance by GPs with indirect and incentivized quality prescribing indicators, included in pay-for-performance programs, compared with not-incentivized indicators based on the relative use of drugs and on the appropriateness prescribing.

Objective Monitoring and feedback to physicians on their prescribing patterns helps to promote change in the areas where it is needed. However, behaviour and satisfaction of general paediatricians with the routine monitoring of their prescribing has not been measured. We aimed to develop a set of valid indicators of prescribing quality in paediatric primary care practice, and to evaluate the satisfaction of paediatricians with such indicators. Methods Prescribing indicators were chosen by consensus-group technique. All paediatricians in the Primary Health Care Area, where the study took place, received feedback with indicators within 1 year. The face validity of these indicators was assessed by collecting data from anonymous questionnaires sent to the paediatricians issuing prescriptions. Key findings Twelve prescribing indicators were identified to be appropriate for assessing the quality of therapeutic management in common illness in children in primary care. Consensus was reached on four indicators suitable for application to continuous monitoring. They focused on the relative use of broad-and narrow-spectrum antibiotics, the relative use of inhaled beta-agonists and inhaled steroids and the relative use of inhaled steroids compared with leukotriene antagonists. Thirty-seven paediatricians (93%) filled out the questionnaire. Antibiotic indicators were well accepted by 92% of them. Fifty-four per cent of paediatricians thought that the proposed asthma indicators do not reflect prescribing quality for this disease. Conclusion Indicators assessing prescribing quality by primary care paediatricians should be based on anti-asthmatics and antibiotics. Periodic feedback with these indicators increases professional satisfaction and contributes to improved drug selection in the opinion of paediatricians. Opinion was divided on the use of such indicators with respect to the distribution of financial incentives.

The compliance of GPs showing compliance with quality prescribing indicators included in pay-for-performance programmes was not better than that of those who showed no compliance with other relevant quality prescribing indicators not linked to financial incentives.

Objectives  Audit and feedback on prescribing patterns is widely used to improve some aspects of prescribing. It is not known whether this strategy increases primary care paediatricians' (PCPs') practice quality. The aim of this study was to assess the impact of postal prescriber feedback on the prescribing patterns of Andalucian PCPs. Methods  A quasi‐experimental intervention study without control group was developed. PCPs received feedback with specific indicators on prescribing patterns during a 2‐year period. Feedback was accompanied by updates of scientific evidence supporting first‐line therapies. Changes in prescribing rates of PCPs, the proportion of PCPs reaching fixed standards and prescriber variability before and during 2 years' intervention were compared. Key findings  Considerable improvement was found in the relative use of first‐line penicillins whereas macrolide use decreased. Prescribing ratios of anti‐asthmatics did not vary significantly. More PCPs reached fixed standards after starting intervention. At the same time, inter‐individual prescribing variability decreased significantly. Conclusions  Continuous audit and feedback combined with educational materials and maintained for a 2‐year period has a positive impact on prescribing PCPs' quality prescribing. The success of the programme would be based on the active involvement of the professionals issuing prescriptions.