The efficacy of an automated feedback system for general practitioners

Abstract

Objective An automated feedback system that produces comments about the non-adherence of general practitioners (GPs) to accepted practice guidelines for ordering diagnostic tests was developed. Before implementing the automated feedback system in daily practice, we assessed the potential effect of the system on the test ordering behaviour of GPs. Design We used a randomised controlled trial with balanced block design. Setting Five times six participant groups of GPs in a computer laboratory setting. Intervention The GPs reviewed a random sample of 30 request forms they filled in earlier that year. If deemed necessary, they could make changes in the tests requested. Next, the system displayed critical comments about their non-adherence to the guidelines as apparent from the (updated) request forms. Subjects Twenty-four randomly selected GPs participated. Main outcome measures The number of requested diagnostic tests (17% with 95% confidence interval [CI]: 12_22%) and the fraction of tests ordered that were not in accordance with the practice guidelines (39% with 95% CI: 28_51%) decreased due to the comments of the automated feedback system. The GPs accepted 362 (50%) of the 729 reminders. Implications Although our experiment cannot predict the size of the actual effect of the automated feedback system in daily practice, the observed effect may be seen as the maximum achievable.

Keywords

• Clinical competence
• clinical decision support systems
• guideline adherence
• practice guidelines
• primary healthcare
• reminder systems
• test ordering