A comparator representing a higher target has the potential to influence prescribing behaviour change, if physicians identify with it
Participants indicated that comparing their performance to others was a key motivation for using the report. Participants who received the median comparator and those that received the top quartile comparator (a higher target) indicated that they aimed to achieve similar prescribing rates to the comparator. It also appeared that efforts to adjust prescribing were reduced when the comparator was reached or was close: this indicates a potential coasting effect (if physicians are close to the comparator, they may not prioritise it). 
“When I’m at the 75th percentile or better, you know, I maybe don’t put as much emphasis on it” (LTC1, benefit, top quartile) “The useful information for me is that either I am using less or I’m using the same as others in the, in Ontario… that’s good enough” (LTC4, risk, median) However, problems with identification with the comparator may negatively impact this. Participants emphasised that their prescribing rates should be considered in the context of the behavioural profile of their residents and that generalized comparators are not always appropriate. Participants discussed at length how their prescribing rates are reflective of the interaction between individual patient characteristics and the facility in which they reside. Various alternative comparators were suggested: for example, comparators based on the proportion of residents with certain cognitive/behavioural scale scores, or similar units (such as the presence of a secure unit). This corresponded to the CFIR domain “My ratio of aggressive behaviours double everybody else’s… so my antipsychotic use is a little higher, which isn’t surprising… Then the comments are, how do you de-prescribe? Well you know what I have a different unit is what my answer is… you can’t rate a percentage of antipsychotic use unless you’re looking at the population I’m dealing with.” (LTC2, benefit, top quartile)