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Objective: To examine how changes in clinical
behaviour and reduction in associated costs could be produced by
utilising strategies that incorporate information about the costs
of pharmaceuticals, pathology, diagnostic imaging and other
services generated by general practitioners.
Data sources: For the years 1980 to 1996 we searched
(1) computerised database (Medline, CINAHL, Health Plan, Embase)
and (2) citations in review articles.
Study selection: The terms used to identify studies
were family practice or physicians/family, primary health care,
knowledge - attitudes - practice, comprehensive health care
combined with costs for fees and charges. Studies were included if
they provided costing information to general practitioners with the
aim to decrease costs by changing behaviour and utilised a randomised
control design, a quasi-randomised controlled trial, crossover
designs or controlled time series.
Data extraction: The information extracted
included study design, intervention used and objective measures of
general practitioner performance/clinical care, which included
test ordering, prescribing, hospital and primary care visits and
costs.
Data synthesis: The inclusion criteria were met by
six studies. The most successful strategies were academic detailing
and computerised feedback.
Conclusion: The review has indicated that changes in
behaviour among general practitioners using the provision of
costing information is possible in all service areas. The
sustainability of these charges has not been well studied.
(MJA 1997)
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