Objectives A previous audit comparing the use of resources between final year trainees in Family Medicine (FM) in Oman and General Practice (GP) in the United Kingdom (UK), showed that, in patients attending for a same day/walk-in appointment, trainees in Oman prescribed significantly more items than those in the UK. The number of investigations ordered was the same although the average age of the patients in Oman was much lower.
The purpose of this project was to reduce what was considered to be over use of these resources.
Method One cohort of 18 FM trainees (2015–2016) in Oman was given anonymised, ranked, performance data, for all the prescription items and investigations they had ordered for walk-in patients the previous month. They were encouraged to think about rational use of these resources and to compare their performance with their peers. The mean prescription items/patient and the mean investigations/patient across the group of residents was calculated with 95% confidence intervals for each outcome. As the number of trainees in the cohort was small and they all worked closely together it was not possible to split them and have a contemporaneous control group. As an alternative control group, the same analysis of prescription and investigations use was carried out for the cohort of FM trainees working the previous year (2014–2015). This group also contained 18 trainees, matched for age, sex and experience.
Results Comparing the five months before and after this intervention, the total number of patients seen was 4228 and 2893 respectively. The total number of investigations fell from 1.27 items/patient (95% CI: 0.95 to 1.59) to 1.16 items/patient (95% CI: 0.96 to 1.36), a reduction of 8.6% and the number of prescriptions fell from 1.79 items/patient (95% CI: 1.66 to 1.92) to 1.57 items/patient (95% CI: 1.48 to 1.66), a reduction of 12.3%. In the 2014–2015 cohort, there was no such reduction. Indeed, there was a tendency toward an increase in use of resources. The total number of investigations increased from 1.01 to 1.22 items/patient and the number of prescriptions increased from 1.82 to 1.91 items/patient. (CI 95% available but no space to include them here)
Conclusions Discussion of the rational use of the resources is an important part of the education of FM trainees in Oman. This study has demonstrated that giving regular (monthly) feedback of anonymised, ranked performance data to these trainees supports a significant reduction in their use of resources. These data were gathered manually. A system to automatically generate and feedback this information should be developed.
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