Effect of feedback on test ordering behaviour of general practitioners.

Winkens, Ron; Pop, P.; Grol, Richard; Kester, A.D.M.; Knottnerus, J. A.

doi:10.1136/bmj.304.6834.1093

Cited by 55 publications

(26 citation statements)

References 11 publications

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“…Information was transmitted to the physicians in various forms, as suggested by Solomon et al (8 ), Valenstein (7 ), and Grimshaw et al (21 ). Our education and feedback information was personalized as extensively as possible and included a form of peer pressure, which could have a strong influence over physician behavior (14,(17)(18)(19). Finally, there were multiple visits over the approximately 2 years of the intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies within the Harvard Community Health Plan were associated with a highly academic facility. The approach of the Winkens group is resource-intensive (17)(18)(19), and beyond the scope of most nonacademic communities.…”

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confidence: 99%

“…We have identified nine studies (11)(12)(13)(14)(15)(16)(17)(18)(19) that examined the effects of various interventions on laboratory utilization by physicians in the out-of-hospital outpatient setting. These community studies were very different from our own.…”

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confidence: 99%

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Effect of a Controlled Feedback Intervention on Laboratory Test Ordering by Community Physicians

Bunting

Walraven

2004

Clinical Chemistry

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Background: Most studies of interventions to reduce laboratory test utilization have occurred in academic hospital settings, used historical controls, or have had short postintervention follow-up. Interventions with the greatest impact use multiple approaches, are repeated regularly, include comparisons with physician peers, and have a personal approach. We determined whether laboratory test utilization by community physicians could be reduced by a multifaceted program of education and feedback. Methods: We identified 200 physicians who ordered the largest number of common laboratory tests during 1 year in a nonhospital, commercial community (reference) laboratory. They were assigned to intervention and control groups (100 each). Intervention physicians were visited individually up to three times by laboratory representatives over a 2-year period. At each visit, educational material and the physician's personal laboratory test utilization data were presented and discussed briefly in general terms, with the latter compared with utilization data for the physician's peers. Overall test utilization rates 1 year before, during, and 2 years after the intervention were measured using population-based databases. Time-series analysis was used to determine the effect of the intervention on laboratory test utilization.

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Section: Discussionmentioning

confidence: 99%

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Effect of a Controlled Feedback Intervention on Laboratory Test Ordering by Community Physicians

Bunting

Walraven

2004

Clinical Chemistry

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“…It has been shown that following the introduction of individual feedback to general practitioners on their use of diagnostic tests, there has been a decrease in the number of requests for tests. 27,28 Providing feedback for the PCPs in this center on their high diagnostic accuracy and pointing out which cases they deemed to be diagnostically inadequate may direct attention to the type of cases requiring diagnostic referrals to the neurology outpatient clinic. The possibility of neurologists holding outpatient clinics in community settings can also be increased.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Agreement between Primary Care Physicians and Neurologists

Al‐Ansary

Al‐Rajeh

1994

Annals of Saudi Medicine

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The ability of primary care physicians (PCPs) to diagnose neurologic disorders was assessed from the records of 166 patients referred to the neurology outpatient clinic in one year. At the time of referral, 74.7% were correctly diagnosed. Primary care physicians were competent in the diagnosis of cerebrovascular accidents, epilepsy, spaceoccupying lesions, dementia, extrapyramidal and cerebellar disorders. More specific diagnosis was difficult at the primary care level in cases of headache, spinal cord and peripheral nerve disorders. The implications of these results and possible reasons for them are discussed. Solutions to improve on this situation are recommended with emphasis on both undergraduate and postgraduate training in neurological bedside skills. The complementary roles of the primary care physician and the neurologist are stressed. Ann Saudi Med 1994;14(3):215-218.LA Al-Ansary, SM Al-Rajeh, Diagnostic Agreement between Primary Care Physicians and Neurologists. 1994; 14(3): 215-218 Disorders that affect the nervous system are frequently encountered in the practice of family medicine. It has been estimated that neurologic disorders affect about 9.5% of the entire United States (US) population.1,2 Each year 2.5% of the population will require the attention of a physician competent in clinical neurology. Herpes zoster, migraine and other severe headaches, and brain trauma have the highest annual incidence rate. 2 In the United Kingdom (UK), the prevalence of nervous system disorders is on the order of 11.2% to 14.4% for both males and females, and has shown an increasing trend in the last 20 years, but still very much of the pattern and scale as in Canada and the US.3,4 Migraine and other severe headaches, epilepsy, stroke and transient ischemic attacks, dementia, and Parkinson disease are the major neurologic disorders that are prevalent in the population. 2,5,6 The most common neurologic problems referred to specialists are those disorders that are most frequently encountered by general practitioners such as headache, epilepsy, and unexplained symptoms such as giddiness and lightheadedness. 4,7 Data on the incidence and prevalence of neurologic disorders in Saudi Arabia are scanty.8 Analysis of consecutive cases seen in the neurology outpatient clinics in the Qassim Region and the Eastern Province showed that seizure disorders, headaches, peripheral neuropathies and stroke were the most commonly encountered disorders in all age groups. 9,10 In both series, inherited disorders were frequent and accounted for 5% to 7% of the cases.Primary care physicians (PCPs) should have sufficient education, training, and experience to recognize and manage most of the common neurological disorders encountered in ambulatory care.

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“…5 There is evidence that rapid access to those results is a costeffective means of improving the appropriateness of the requests for laboratory investigations. 6,7 The Grampian study of a guideline-based open access urological investigation service demonstrated improved patient waiting times when appropriate investigations were ordered and reviewed by GPs. 8 A systematic review by a group in Boston, USA showed that feedback of …”

Section: Introductionmentioning

confidence: 99%