Pharmacotherapeutic Circles: Results of an 18-Month Peer-Review Prescribing-Improvement Programme for General Practitioners

Objective: To assess the effectiveness of the pharmacotherapeutic circle (PTC), a general practitioner (GP) prescribing-improvement programme to enhance prescribing quality and reduce drug costs. Design: Combined pre- and post-intervention time-series design using an internal comparison of subgroups and an external comparative control. Setting: Small discussion groups meeting 8 times over 18 months. Participants: 79 GPs exceeding the mean drug costs/patient of all Hessian physicians by >=40%; 10 moderators. Interventions: Peer-review feedback of prescription patterns based on guidelines targeting 3 suboptimal prescribing areas: drug prescriptions lacking evidence-based efficacy (target A); presumptive prescribing habits (target B); and underprescribing of new, effective therapies (target C). Main outcome measures and results: Significant decreases in prescription rates for target A drugs were recorded for varicose vein medications (p = 0.006), peripheral vasodilators (p = 0.0001) and topical antirheumatics (p = 0.0145), but not for prokinetics/enzymes/digestives. Prescribing of target B drugs such as benzodiazepines and nonsteroidal anti-inflammatory drugs declined markedly (p = 0.0019 and 0.0014, respectively). Target C drug prescriptions such as for opioids and proton pump inhibitors were not significantly increased. Highly significant reductions in prescription costs were observed for target A and B drugs, irrespective of whether GPs were stratified into high, medium or low prescribers. When mean prescribing costs for PTC participants were compared with those of a control group comprising 8000 GPs over a 21-month period, PTC GPs decreased their costs by 2%, whereas drug costs for all Hessian physicians rose by 10%. Conclusions: PTCs appear to be an effective method to optimise the quality of drug prescribing and reduce drug costs.