[Comparison of two models of prescription quality indicators in primary care]. / Comparación de dos modelos de indicadores de la calidad de la prescripción farmacéutica en atención primaria.

OBJECTIVES: To assess the quality of prescriptions in primary care area through indicators established by a team of physicians and to analyze the relationship between these indicators and those used by the Spanish public health system (INSALUD) in the same area. METHODS: An observational, cross sectional study was performed in a primary care area in Asturias with 156,614 inhabitants and 9 health centers. An overall quality score was obtained for each of the physicians in the primary care area by using quality indicators and standards agreed on by the prescribers themselves. The relationship between the score obtained and the indicators normally used in the area by INSALUD and pharmaceutical cost was also analyzed. RESULTS: Mean compliance with the optimal standard was 29%. The mean overall quality score was 3.24. None of the physicians achieved the maximum score of 11. No significant association was found between the score and the indicators for drugs of limited clinical value. Adherence to the pharmaceutical guide for the area was positively correlated with quality (r = 0.44, p < 0.001). A negative linear association (p < 0.001) was found between the overall quality score and incurred cost. The adjusted coefficient of determination was 0.29. CONCLUSIONS: Poor prescribing quality was widespread. Indicators for drugs of limited clinical value, frequently used as a measure of quality, showed no relationship with quality. Adherence to the area's pharmaceutical guide remains a valid indicator of prescribing quality. Overall, there was a correlation between higher quality and lower prescribing cost, although this correlation was not found for individual physicians.

[A system, developed by prescribing doctors, of indicators of the quality of pharmaceutical prescription in primary care]. / Un sistema de indicadores de calidad de prescripción farmacéutica en atención primaria desarrollado por médicos prescriptores.

OBJECTIVE: To work out a system of indicators and standards, designed by means of a consensus group of general practitioners, that enables evaluation of the quality of Primary Care prescription to be improved. Design. Informal consensus method. SETTING: A PC area in Asturias with 156 614 inhabitants and 9 health centres.Participants. Nine PC doctors accepted voluntarily to take part in the project. METHOD: A consensus group of nine PC doctors was formed. At a first meeting they worked out some potential indicators of quality of prescription. After applying these indicators to the prescription data, a second meeting was held, at which the results of applying the indicators along with criteria of excellence were used to establish the definitive indicators and their numerical values of optimum compliance. RESULTS: It was possible to agree by consensus 11 indicators of quality of prescription and their values of optimum compliance. Eight of the indicators referred to choice of a medicine within a pharmaco-therapeutic group; and three, to groups in which the volume of prescription may suggest improper usage. CONCLUSIONS: It is feasible for PC doctors to reach a consensus on a group of criteria that is perceived as valid for measuring quality of prescription and which includes certain impalpable values for determining quality.

[Factors that affect the prescription of benzodiazepines and actions to improve their use: a Delphi study of primary care doctors]. / Factores que influyen en la prescripción de benzodiacepinas y acciones para mejorar su uso: un estudio Delphi en médicos de atención primaria.

OBJECTIVES: To identify the factors that affect the prescription of benzodiazepines and similar drugs and the actions that can be taken to reduce their prescription.Design. Consensus method. Delphi technique. SETTING: Four primary care areas in Asturias. Participants. 39 doctors from primary care teams agreed voluntarily to take part in the study, and 32 completed the study. They belonged to 20 health centres. METHOD: They were sent by mail three questionnaires one after the other. The second and third questionnaires were worked out on the basis of the analysis of the information from the replies to the preceding questionnaire. Those who did not send in a reply were reminded by phone. RESULTS: The 5 most influential factors in benzodiazepine prescription were agreed: reduction in the threshold of tolerance of emotional discomfort; increase of the prevalence of pathologies; lack of time in the consulting-room; social and economic conditioning factors; properties of the benzodiazepine family. The 5 most important actions that could reduce prescription of these drugs were agreed: general health education; reduction in case loads; making doctors more conscious of prescribing correctly; strengthening the social support network; doctors fomenting use of effective alternative treatments. CONCLUSIONS: The prescription of benzodiazepines and their analogues is a multi-factorial action with social and psychological roots. The action most voted on to reduce their prescription was general health education.

[Impact of a pharmacotherapy bulletin at a primary health care area]. / Estudio del impacto de un boletín farmacoterapéutico en un área de atención primaria.

OBJECTIVE: To evaluate the impact of the recommendations in the bulletin of pharmacotherapeutic information on the prescription of iron salts by the area's doctors. DESIGN: Intervention study with control group. SETTING: Two primary care areas in Asturias. PARTICIPANTS: Intervention group: 93 doctors from area 3. CONTROL GROUP: 59 doctors from area 7. INTERVENTIONS: In March 97 an informative bulletin was issued recommending the use of ferrous salts rather than ferric salts and was sent to all area 3's doctors. MEASUREMENTS AND MAIN RESULTS: The PFe2 indicator was calculated: defined daily dose percentage of ferrous salts out of total iron salts in three time periods: January-March '97 (t1), April-June '97 (t2) and January-March '98 (t3). In the intervention group, the PFe2 value increased progressively in the three periods. There were significant differences between t1 and t3 (mean increase: 6.0%, 95% CI: 1.9%-10.1%, p = 0.004) and between t2 and t3 (mean increase: 4.5%, 95% CI 0.8%-8.3%, p = 0.017), whereas the differences were not significant between t1 and t2 (mean increase 1.5%, 95 CI 1.3%-4.2%, p = 0.296). The respective values for the controls only showed significant differences for variation in periods t2 and t3 (mean increase: 2.0%, 95% CI 0.2%-3.8%, p = 0.017). CONCLUSIONS: 1. The bulletin issued in the area had a favourable impact. 2. This impact could only be seen in the medium term, not in the short term.

[User satisfaction in a health district. Differences according to the care model]. / Satisfacción de los usuarios de una zona de salud. Diferencias según modelo asistencial.

OBJECTIVES: To evaluate user satisfaction with their medical care, in relation to some points of care procedures, and to study the association between medical care and the care model. DESIGN: A descriptive cross-sectional study, carried out through a telephone poll. SETTING: Primary Care. PATIENTS AND OTHER PARTICIPANTS: Systematic randomised sample of 538 users, who were listed at a Health Centre as having an individual health card. MEASUREMENTS AND MAIN RESULTS: There was a 73.8% reply rate, with a total of 397 valid polls. Total Cronbach's alpha of the variables concerning satisfaction was 0.91. There were no differences in the sociodemographic variables between the users of the two care models. Waiting time before entering the consulting room was significantly greater among users of the reformed model (RM) than the traditional model (TM) (P < 0.00001). Variables associated with satisfaction with the doctor were: doctor's interest in the patient's problems, assessment of the time spent by the doctor in clinical investigation, agreement with the doctor's prescription, clarification of doubts, use of the clinical history and overall satisfaction with the medical care received. RM doctors were found more satisfactory for all these variables (p < 0.00001). CONCLUSIONS: These findings showed greater satisfaction among RM users.