Dutch research has suggested that peer review schemes fail to reduce the level of GP prescribing, nor do they result in decreasing the value of tests ordered.
Scientists from the Netherlands concluded that the peer review process “may not be useful to deliver better adherence of guidelines and contain costs” in regards to GP prescribing and test ordering.
The study was published in BioMed Central Family Medicine, and represented the first time that peer review schemes have been attested outside of general research settings.
Previous studies have suggested auditing and feedback from peers may be useful methods of tackling overprescribing.
The theory is that this would influence needless test ordering behaviour from GPs.
Peer review schemes have been recommended by NICE as another way of limiting GP prescribing, but it seems that this may be somewhat flawed.
Nice guidance suggests that peer review can help in gaining control over antibiotic prescribing in local regions.
However, Nice has also stated that this is a recommendation rather than mandatory policy.
With the guidance due to be reviewed on a two-yearly basis, it seems that an update to this policy may indeed be due, with the last such assessment having been presented in 2015.
Meanwhile, the authors of the new research suggested that a lack of confidence and adherence to the strategy may have contributed to its failings.
Some participants “felt it was too complex and too ambitious”.
The scale of the study will lead many to conclude that its findings are valid, with 88 GP practices in the southern region of the Netherlands having been assessed.
Anaemia, rheumatic complaints, UTI, chlamydia, stomach complaints and type 2 diabetes were all assessed over a three-year period.
The researchers concluded that their findings challenged the conventional orthodoxy regarding peer review.
“Our study found that the beneficial results obtained in earlier, well-controlled studies were not confirmed when we introduced this intervention in existing primary care. Although we provided complete transparency on the data sources and instructed the moderators in this respect, we learned from the process evaluation that the source of the feedback was often not clear to the participants.”
They also suggested that the nature and efficacy of working agreements could have a big influence over both the results and the practical operation of surgeries in the real world.
“We found that many groups failed to set achievable and measurable working agreements. More than half of the meeting reports we received from groups did not contain specific, achievable, realistic or measurable working agreements.”