Quality circles to improve prescribing of primary care physicians. Three comparative studies.

Contains fulltext : 81801.pdf (publisher's version ) (Closed access)PURPOSE: To determine the effectiveness of quality circles on prescribing patterns of primary care physicians in Germany and to explore the influence of specific factors on changes. METHODS: Three large non-randomised comparative studies were performed in primary care in Germany, with baseline measurements in 2001 and follow-up measurements in 2003. 1090 physicians were in intervention groups and 2090 physicians in control groups. For each physician, data on 444 patients and 1201 prescriptions were available, on average, at each measurement moment. Quality circles comprising of a series of small group moderated meetings of physicians, provision of evidence-based information and repeated written feedback on individual prescribing patterns. RESULTS: Compared to the control groups, physicians in the intervention groups reduced mean prescription cost per patient per 3-month period by 1.87 euro (95%CI 0.51 to 3.22), increased generic drugs of all potentially generic prescriptions by 0.75% (95%CI 0.40 to 1.10), increased prescription of recommended lipid lowering drugs by 4.24% (95%CI 2.40 to 6.10), increased the prescription of recommended antibiotics by 1.72% (95%CI 0.33 to 3.10). Groups with more positive views of performance feedback, evidence-based indicators and price comparisons showed more change of prescribing. CONCLUSIONS: Quality circles had a modest effect on prescribing quality and costs. If widely implemented, they could have nationwide impact on the quality and costs of prescribing in primary care

Crowning glory: public law, power and the monarchy

‘New public law’ has a keen interest in the deployment of power and the shifting nature of the public and private. In this article, we argue that the historical legacy of the Crown has hindered the ability of public lawyers to respond to changes in modes of governance in the UK. The constitutional law textbook tradition has played a key role in limiting critiques of the Crown because of the obfuscation that surrounds the legal and political status of the Monarch. However, instead of discounting the significance of the monarchy, we use it as a resource for exploring governing power, the blurring of boundaries and constitutional renewal. Our starting point is the life, death and, most importantly, the funeral of Diana, Princess of Wales. The latter event exposed the political relevance of the ‘personal’ in a most dramatic way, generating claims about the ‘feminisation of the government’ and ‘emotions augmenting democracy’. We follow through on these claims in order to focus on the effects of adopting private, intimate-sphere norms in the public sphere, in particular public-sphere decision making. While aware of the risks associated with this ‘transformation’ of democracy, we conclude that the increasing centrality of the intimate merits onsideration in new public law’s search for progressive tools of modern governance