Frans is 63 en voelt zich prima, hij heeft wel hypertensie en sinds enkele jaren ook diabetes. Me... more Frans is 63 en voelt zich prima, hij heeft wel hypertensie en sinds enkele jaren ook diabetes. Met evidence-based richtlijnen in de hand zet u het optimale beleid uit voor deze patiënt.
International research has proved that academic detailing positively influences the prescribing b... more International research has proved that academic detailing positively influences the prescribing behaviour of physicians. In the North-East Flanders region of Belgium, a quantitative study of the feasibility and acceptability of academic detailing in general practice has demonstrated that academic detailers are appreciated by physicians. In addition to the quantitative study, a qualitative study was carried out to determine physicians' attitudes to academic detailing and their objections against it. This study took place in general practice in the North-East Flanders region of Belgium, using semistructured interviews. Nineteen physicians who had previously had a visit from an academic detailer in the quantitative study, and 19 who had refused were invited for an interview. Eighteen physicians who had been visited by an academic detailer, and nine who had refused a visit agreed to be interviewed. Although most physicians who had had a visit from an academic detailer appreciated the visit, some barriers were revealed. Physicians had doubts about the objectivity, stated that the information was not new or that they had other ways to obtain information. These barriers were also mentioned by the physicians who had refused a visit. Additional barriers were that the visits were time-consuming, meant to cut expenses, politically coloured, and patronising. Doubts about independence and objectivity of the information were stated as important barriers both by physicians who had accepted a visit from an academic detailer and by those who had not. These issues need to be dealt with when designing future interventions with academic detailers.
International research has proved that academic detailing positively influences the prescribing b... more International research has proved that academic detailing positively influences the prescribing behaviour of physicians. In the North-East Flanders region of Belgium, a quantitative study of the feasibility and acceptability of academic detailing in general practice has demonstrated that academic detailers are appreciated by physicians. In addition to the quantitative study, a qualitative study was carried out to determine physicians' attitudes to academic detailing and their objections against it. This study took place in general practice in the North-East Flanders region of Belgium, using semistructured interviews. Nineteen physicians who had previously had a visit from an academic detailer in the quantitative study, and 19 who had refused were invited for an interview. Eighteen physicians who had been visited by an academic detailer, and nine who had refused a visit agreed to be interviewed. Although most physicians who had had a visit from an academic detailer appreciated the visit, some barriers were revealed. Physicians had doubts about the objectivity, stated that the information was not new or that they had other ways to obtain information. These barriers were also mentioned by the physicians who had refused a visit. Additional barriers were that the visits were time-consuming, meant to cut expenses, politically coloured, and patronising. Doubts about independence and objectivity of the information were stated as important barriers both by physicians who had accepted a visit from an academic detailer and by those who had not. These issues need to be dealt with when designing future interventions with academic detailers.
Rationale In Belgium, several policies regulating reimbursement of acid suppressant drugs and ev... more Rationale In Belgium, several policies regulating reimbursement of acid suppressant drugs and evidence-based recommendations for clinical practice were issued in a short period of time, creating a unique opportunity to observe their effect on prescribing. Aims and objectives To describe the evolution of prescriptions for acid suppressants and explore the interaction of policies and practice recommendations with prescribing patterns. Method Monthly claims-based data for proton pump inhibitors (PPIs) and H2-antihistamines by general practitioners, internists and gastroenterologists were obtained from the Belgian national health insurance database (1997–2005). The evolution of reimbursed defined daily doses and expenses after introduction of reimbursement regulations and dissemination of practice recommendations was explored. Results Recommendations had no impact on prescribing. All changes can be related to concomitant policies. Lifting reimbursement restrictions for cheaper products did not control growth or save costs in the long term. Only restricting reimbursement of all PPIs managed to curb the growth. We observed an unintended increase of non-omeprazole PPIs by gastroenterologists. Conclusions Reimbursement policies influence prescribing, but their effect can be unintended. A dialogue between policymakers and guideline developers, and evidence-based policies that are linked to clinical guidelines, could be an effective way to pursue both cost-containment and quality of care.
Frans is 63 en voelt zich prima, hij heeft wel hypertensie en sinds enkele jaren ook diabetes. Me... more Frans is 63 en voelt zich prima, hij heeft wel hypertensie en sinds enkele jaren ook diabetes. Met evidence-based richtlijnen in de hand zet u het optimale beleid uit voor deze patiënt.
International research has proved that academic detailing positively influences the prescribing b... more International research has proved that academic detailing positively influences the prescribing behaviour of physicians. In the North-East Flanders region of Belgium, a quantitative study of the feasibility and acceptability of academic detailing in general practice has demonstrated that academic detailers are appreciated by physicians. In addition to the quantitative study, a qualitative study was carried out to determine physicians' attitudes to academic detailing and their objections against it. This study took place in general practice in the North-East Flanders region of Belgium, using semistructured interviews. Nineteen physicians who had previously had a visit from an academic detailer in the quantitative study, and 19 who had refused were invited for an interview. Eighteen physicians who had been visited by an academic detailer, and nine who had refused a visit agreed to be interviewed. Although most physicians who had had a visit from an academic detailer appreciated the visit, some barriers were revealed. Physicians had doubts about the objectivity, stated that the information was not new or that they had other ways to obtain information. These barriers were also mentioned by the physicians who had refused a visit. Additional barriers were that the visits were time-consuming, meant to cut expenses, politically coloured, and patronising. Doubts about independence and objectivity of the information were stated as important barriers both by physicians who had accepted a visit from an academic detailer and by those who had not. These issues need to be dealt with when designing future interventions with academic detailers.
International research has proved that academic detailing positively influences the prescribing b... more International research has proved that academic detailing positively influences the prescribing behaviour of physicians. In the North-East Flanders region of Belgium, a quantitative study of the feasibility and acceptability of academic detailing in general practice has demonstrated that academic detailers are appreciated by physicians. In addition to the quantitative study, a qualitative study was carried out to determine physicians' attitudes to academic detailing and their objections against it. This study took place in general practice in the North-East Flanders region of Belgium, using semistructured interviews. Nineteen physicians who had previously had a visit from an academic detailer in the quantitative study, and 19 who had refused were invited for an interview. Eighteen physicians who had been visited by an academic detailer, and nine who had refused a visit agreed to be interviewed. Although most physicians who had had a visit from an academic detailer appreciated the visit, some barriers were revealed. Physicians had doubts about the objectivity, stated that the information was not new or that they had other ways to obtain information. These barriers were also mentioned by the physicians who had refused a visit. Additional barriers were that the visits were time-consuming, meant to cut expenses, politically coloured, and patronising. Doubts about independence and objectivity of the information were stated as important barriers both by physicians who had accepted a visit from an academic detailer and by those who had not. These issues need to be dealt with when designing future interventions with academic detailers.
Rationale In Belgium, several policies regulating reimbursement of acid suppressant drugs and ev... more Rationale In Belgium, several policies regulating reimbursement of acid suppressant drugs and evidence-based recommendations for clinical practice were issued in a short period of time, creating a unique opportunity to observe their effect on prescribing. Aims and objectives To describe the evolution of prescriptions for acid suppressants and explore the interaction of policies and practice recommendations with prescribing patterns. Method Monthly claims-based data for proton pump inhibitors (PPIs) and H2-antihistamines by general practitioners, internists and gastroenterologists were obtained from the Belgian national health insurance database (1997–2005). The evolution of reimbursed defined daily doses and expenses after introduction of reimbursement regulations and dissemination of practice recommendations was explored. Results Recommendations had no impact on prescribing. All changes can be related to concomitant policies. Lifting reimbursement restrictions for cheaper products did not control growth or save costs in the long term. Only restricting reimbursement of all PPIs managed to curb the growth. We observed an unintended increase of non-omeprazole PPIs by gastroenterologists. Conclusions Reimbursement policies influence prescribing, but their effect can be unintended. A dialogue between policymakers and guideline developers, and evidence-based policies that are linked to clinical guidelines, could be an effective way to pursue both cost-containment and quality of care.
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