ABSTRACT
OBJECTIVES: With a system of qualitative indicators, to analyse the pharmaceutical prescription of general practitioners (GPs), and to evaluate the relationship of these indicators to the overall pharmaceutical prescription expenditure per inhabitant. DESIGN: Retrospective descriptive study. SETTING: Primary care. MEASUREMENTS AND MAIN RESULTS: The drugs prescription of 285 GPs from 32 primary care teams was evaluated, with the individual prescription of each doctor as the unit of analysis. The prescription was classified in 3 categories according to its intrinsic value (IV): low (< or = 75%), medium (76-79%) and high (> or = 80%). Selected as tracers of over-prescription were: daily dose per inhabitant (DDI) of antibiotics (AB), DDI of non-steroid anti-inflammatory drugs (NSAID), and DDI of ulcer drugs (ULC). Selected as tracers of selection were: % DDI third-generation cephalosporins/DDI total cephalosporins; % DDI broad-spectre quinolones/DDI total quinolones; and % DDI NSAID/DDI NSAID plus analgesics. Quantitative indicators studied were: total expenditure per allocated population, cost per drugs prescription of doubtful efficacy, and cost per daily dose of AB, NSAID and ULC. Variance analysis, including the Scheffe test for multiple comparisons and Pearson's linear correlation, was applied. 26% of the prescriptions had an IV below 75%, and 34% had an IV above 80%. The means of DDI of AB among the categories of IV were different (p < 0.0001), as were those of DDI of NSAID (p < 0.0001) and of ULC (p = 0.007). Lower consumption of AB, NSAID and ULC was found in prescriptions with the highest IV %. The third-generation cephalosporins and the NSAID + analgesics showed significant differences in the three IV categories (p < 0.0001 and p = 0.041), unlike broad-spectrum quinolones (p = 0.18). The total expenditure per allocated population was less for GPs whose prescriptions had the highest IV %; whereas the cost per prescription and cost per daily dose showed no significant differences for IV categories. CONCLUSIONS: The doctors with the best qualitative profile on these indicators had less expenditure per inhabitant. However, no differences were found in the cost per prescription or cost per treatment between doctors. Therefore, interventions must prioritize improving drug prescription quality rather than just promoting changes to lower-cost drugs.
Subject(s)
Drug Prescriptions/economics , Drug Prescriptions/standards , Costs and Cost Analysis , Humans , Primary Health Care , Retrospective Studies , SpainABSTRACT
Objetivo. Analizar la prescripción farmacéutica de los médicos generales (MG) según un sistema de indicadores cualitativos y evaluar la relación de éstos con el gasto global de prescripción farmacéutica por habitante. Diseño. Estudio descriptivo, retrospectivo. Emplazamiento. Atención primaria. Mediciones y resultados principales. Se evalúa la prescripción farmacéutica de 285 MG de 32 equipos de atención primaria, siendo la prescripción individual de cada médico la unidad de análisis. La prescripción se clasificó en 3 categorías según su valor intrínseco ( por cientoVIF): bajo (ó 75 por ciento), medio (76-79 por ciento) y alto (>= 80 por ciento). Como trazadores de hiperprescripción fueron seleccionados: DHD antibióticos (AB), DHD antiinflamatorios no esteroides (AINE) y DHD antiulcerosos (ULC), y como trazadores de selección: por cientoDHD cefalosporinas tercera generación/DHD cefalosporinas totales (CEF3.ªG), por cientoDHD quinolonas amplio espectro/DHD quinolonas totales (QAP), por cientoDHD AINE/DHD (AINE + analgésicos) (ANAL). Los indicadores cuantitativos estudiados fueron: gasto total/población asignada (GPA), coste/receta fármacos de eficacia dudosa y coste/DDD de AB, AINE y ULC. Se aplicó el análisis de variancia, incluyendo la prueba de Scheffe para comparaciones múltiples y la correlación lineal de Pearson. Un 26 por ciento de las prescripciones tenía un por cientoVIF 80 por ciento. Las medias de DHD AB entre las categorías de VIF eran diferentes (p < 0,0001), al igual que las de DHD de AINE (p < 0,0001) y ULC (p = 0,007), observándose un menor consumo de AB, AINE y ULC en las prescripciones con VIF más alto. Las CEF3ªG, así como ANAL presentan diferencias significativas con las 3 categorías de VIF (p < 0,0001 y p = 0,041) a diferencia del QAP (p = 0,18). El GPA es menor entre los MG cuyas prescripciones tenían el por cientoVIF más alto; en cambio, el coste/receta y el coste DDD no presentaron diferencias significativas según categorías de por cientoVIF. Conclusiones. Los médicos con mejor perfil cualitativo según estos indicadores presentan un menor gasto por habitante. En cambio, no se observan diferencias en el coste por receta ni en el coste/tratamiento entre los distintos médicos. Por tanto, las intervenciones deben priorizar la mejora de la calidad de la prescripción farmacéutica antes que promover únicamente el cambio al fármaco de menor coste (AU)
Subject(s)
Male , Infant , Infant, Newborn , Female , Humans , Patient Care Team , Risk Factors , Spain , Socioeconomic Factors , Retrospective Studies , Primary Health Care , Drug Prescriptions , Costs and Cost Analysis , Hospitalization , Hospitals, UniversityABSTRACT
OBJECTIVE: To describe the use of drugs to combat hypertension and to assess prescription in function of their counterindications to diuretics and beta blockers. DESIGN: A descriptive cross-sectional study by means of an outside audit of clinical records. SETTING: 11 urban Health Districts opened before 1991. PARTICIPANTS: 326 histories of adult hyperintense patients under pharmacological treatment were chosen at random (June-December, 1994). MEASUREMENTS AND MAIN RESULTS: Data were gathered on age, sex, present and former medication, reason for change, and counter-indications to diuretic or beta blocker treatments. Average age was 64.7 (SD 11.6); 66% were women. 437 active principles (AP) were used, of which Enalapril (68 patients) and Captopril (67) were the most common. 203 patients (62.3%; Cl 95%, 57.0-67.5) took one AP; 90 (27.6%; Cl 95%, 22.8-32.5) took two APs; 30 (9.2%), three APs; and 3 (0.9%), four APs. 47.8% of monotherapy was performed with ACE inhibitors; 27.6% with calcium antagonists; 15.3% with diuretics; 7.9% with beta blockers and 1.5% with alpha inhibitors. Diuretics were the drugs most commonly used in association. CONCLUSIONS: There is little use of diuretics and beta blockers, but two-thirds of the prescription of other treatments are justified by a counter-indication to first-choice drugs.
