An educational programme for peer review groups to improve treatment of chronic heart failure and diabetes mellitus type 2 in general practice

J Eval Clin Pract. 2006 Dec;12(6):613-21. doi: 10.1111/j.1365-2753.2005.00625.x.


Rationale, aims and objectives: Peer review groups are considered helpful for quality improvement in primary care. An interactive educational programme for small peer groups was developed, focusing on the implementation of newly developed treatment guidelines. The aim is to evaluate the effect of the programme on adherence to treatment guidelines in general practice.

Methods: A cluster randomized trial using a balanced incomplete block design was used; one arm received a programme on treatment of chronic heart failure (CHF), the other on hypertension treatment in diabetes mellitus type 2 (T2DM). A random sample of 10 CHF and 10 T2DM patients per GP was drawn, for whom data were extracted from electronic patient records 1 years before and 6 months after the intervention. The outcomes were prescribing of ACE inhibitors, and antihypertensive treatment in T2DM. The effect was analysed separately for both programmes using multilevel regression models.

Results: All 27 peer review groups in one region in the Netherlands were randomized, of which 16 participated. No significant effects were observed in the CHF group or in the T2DM group. The opportunity for change was limited, as only 53% of the CHF patients and 60% of the T2DM patients had a contact with their GP between the intervention and follow-up measurement.

Conclusion: The peer review programme was not successful for changing the treatment of chronic patients, although the programme focused on dealing with barriers perceived by the participants. Not all problems perceived can be solved in a peer group discussion.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Antihypertensive Agents / therapeutic use*
  • Chronic Disease
  • Cluster Analysis
  • Diabetes Mellitus, Type 2 / complications*
  • Education, Medical, Continuing / methods*
  • Family Practice / standards*
  • Female
  • Guideline Adherence*
  • Heart Failure / drug therapy*
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / etiology
  • Male
  • Netherlands
  • Outcome Assessment, Health Care
  • Peer Review*
  • Program Evaluation
  • Regression Analysis
  • Surveys and Questionnaires


  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents