Abstract and Introduction
Abstract
Study Objective: To develop and evaluate a peer review group (PRG) meeting using feedback data on a patient level to improve the quality of drug therapy for prevention of recurrent myocardial infarction.
Design: Prospective follow-up study.
Data Source: General practitioners' computerized patients records (intervention patients) and the PHARMO record linkage system (controls).
Patients: Forty patients in the intervention group and 1030 control patients; both groups had documented myocardial infarction.
Intervention: The intervention, which was based on the principles of group academic detailing, consisted of scoring current cardiovascular treatment on separate forms for each patient, presenting an overview of, and discussing, evidence-based treatment after myocardial infarction, defining the target population, formulating a binding consensus, and identifying patients who were eligible for improvement of pharmacotherapy.
Measurements and Main Results: Drug therapy and adherence to the newly formulated PRG consensus were assessed at baseline and 1 year after the intervention. Of the patients who received the intervention and were not treated according to the PRG consensus at baseline, 40% received treatment according to the consensus 12 months after the PRG meeting. In the control group, the proportion of patients was 9.5% (prevalence ratio 4.2, 95% confidence interval 1.8–9.7).
Conclusion: Peer review group meetings can be a valuable tool for improving pharmacotherapy after myocardial infarction.
Introduction
Group academic detailing has been an effective way to improve the quality of pharmacotherapy. In the Netherlands, the principles of group academic detailing can be applied to peer review groups (PRGs). These groups consist of general practitioners and community pharmacists who meet regularly to discuss and improve pharmacotherapy. The establishment of PRGs was encouraged by the Dutch government, based on the assumption that the exchange of knowledge about existing and new therapies would improve the quality of treatment of individual patients. Some peer review groups include specialist physicians as well as general practitioners, but these are rare.
Most of the 7500 Dutch general practitioners and 2600 community pharmacists are organized in 840 PRGs that meet approximately 4 times/year. Their meetings offer the opportunity to exchange knowledge about new therapies, and to discuss both new and existing treatment strategies and the quality of treatment of individual patients. Some PRGs commit themselves to evidenced-based prescribing, and check their commitments afterward by using prescription data. Approximately 64% of the PRGs are limited to the exchange of information only. About 36% of the PRGs reach consensus. Although approximately 80% of the groups use feedback data, only 8% use the data to evaluate the implementation of local guidelines. These feedback data are not presented on an individual patient level but involve aggregated prescription data, which concern an overall percentage of patients receiving treatment. Data on a patient level concern treatment for an individual patient.
Pharmacists do not have access to the medical records kept by general practitioners, but they do have a virtually complete overview of both general practitioner and specialist prescriptions due to a strong pharmacy-patient liaison. Therefore, most PRGs working with prescription figures and feedback select topics based on drug therapy, or on diseases and conditions that can be identified by drug therapy. Some conditions are not easily identifiable using prescription data and, therefore, are less likely to be discussed. Myocardial infarction is one such condition.
Myocardial infarction is a major cause of death in the Netherlands and in all other developed countries. Therefore, prevention of future cardiovascular events in patients who have experienced myocardial infarction should receive proper attention. Previous surveys concerning prevention of recurrent myocardial infarction in primary care have found that dissemination of evidence-based treatment to routine clinical practice remains low. Treatment with β-blockers and angiotensin-converting enzyme (ACE) inhibitors in particular remains disappointingly low.
In the Netherlands, the PRG meeting is a widely used instrument to improve the quality of pharmacotherapy. Although one study proved that PRG meetings affected the prescribing of anticholinergic antidepressants, little is known about the effectiveness of PRG meetings in daily practice. In addition, practically all PRGs use aggregated feedback data and no prescription data on a patient level. Therefore, we planned and evaluated a PRG meeting using feedback data on a patient level to improve the quality of drug therapy for preventing recurrent myocardial infarction.