Peer review schemes do not reduce GP prescribing, study suggests

Peer review schemes do not curtail GP prescribing nor reduce the volume of tests ordered, research conducted in practices across the Netherlands has suggested.

Peer review schemes ‘may not be useful to deliver better adherence of guidelines and contain costs’ in regards to GP prescribing and test ordering, a study has shown.

Researchers said the study, published in BioMed Central Family Medicine, marked the first time peer review schemes had been tested at a large scale outside of well-controlled research settings, casting doubt on the strategy’s effectiveness.

Previous studies have suggested auditing and feedback from peers may be useful methods of tackling overprescribing and limiting needless spending by influencing GPs’ prescribing and test ordering behaviour.

Peer review schemes have been recommended as ways of limiting GP prescribing in the UK. The latest NICE antimicrobial stewardship guidance advocates the use of peer review schemes as a way to take control of antibiotic prescribing in local areas.

A NICE spokesman said the recommendation was guidance, not a mandatory requirement. Last updated in 2015, he added that the institute would consider new evidence such as this every two years – meaning an update may be due.

Peer review schemes

The authors suggested that lack of confidence and adherence to the strategy may have contributed to its failings, in addition to peer groups setting unrealistic targets. Some participants ‘felt it was too complex and too ambitious’, they added.

The study ran from 2008 to 2011, spread across 88 GP practices in the southern Netherlands.

Practices were randomly assigned to one of two trial arms, which were received the same intervention of peer review on five different clinical topics. The practices acted as blind controls for those in the other arm that did not receive intervention in the same clinical area.

The 10 clinical topics included anaemia, rheumatic complaints, UTI, chlamydia, stomach complaints and type 2 diabetes.

The researchers said: ‘Our study found that the beneficial results obtained in earlier, well-controlled studies were not confirmed when we introduced this intervention in existing primary care.

‘Although we provided complete transparency on the data sources and instructed the moderators in this respect, we learned from the process evaluation that the source of the feedback was often not clear to the participants.

‘We found that many groups failed to set achievable and measurable working agreements. More than half of the meeting reports we received from groups did not contain specific, achievable, realistic or measurable working agreements.’

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