Quality circles to improve prescribing of primary care physicians. Three comparative studies

To determine the effectiveness of quality circles on prescribing patterns of primary care physicians in Germany and to explore the influence of specific factors on changes.

Three large non-randomised comparative studies were performed in primary care in Germany, with baseline measurements in 2001 and follow-up measurements in 2003. 1090 physicians were in intervention groups and 2090 physicians in control groups. For each physician, data on 444 patients and 1201 prescriptions were available, on average, at each measurement moment. Quality circles comprising of a series of small group moderated meetings of physicians, provision of evidence-based information and repeated written feedback on individual prescribing patterns.

Compared to the control groups, physicians in the intervention groups reduced mean prescription cost per patient per 3-month period by 1.87 euro (95%CI 0.51 to 3.22), increased generic drugs of all potentially generic prescriptions by 0.75% (95%CI 0.40 to 1.10), increased prescription of recommended lipid lowering drugs by 4.24% (95%CI 2.40 to 6.10), increased the prescription of recommended antibiotics by 1.72% (95%CI 0.33 to 3.10). Groups with more positive views of performance feedback, evidence-based indicators and price comparisons showed more change of prescribing.

Quality circles had a modest effect on prescribing quality and costs. If widely implemented, they could have nationwide impact on the quality and costs of prescribing in primary care.