Selección de indicadores para la monitorización continua del impacto de programas de optimización de uso de antimicrobianos en Atención Primaria / Selection of indicators for continuous monitoring of the impact of programs optimizing antimicrobial use in Primary Care

OBJETIVOS: Construir indicadores básicos para el seguimiento y monitorización de la prescripción y uso adecuado de antimicrobianos en Atención Primaria, en base a las recomendaciones basadas en la evidencia y valorar la factibilidad de los indicadores resultantes para la monitorización de los antibióticos. MÉTODOS: Se realizó una revisión bibliográfica sobre indicadores de calidad de la prescripción de antimicrobianos a través de una búsqueda electrónica, limitándose al periodo 2001-2012. Se completó con una búsqueda «ad hoc» en las páginas web de los Servicios de Salud nacionales e internacionales. Los indicadores finales fueron elegidos por consenso por un grupo multidisciplinar de profesionales con dedicación al manejo de las infecciones desde varios ámbitos. Se verificó la factibilidad y la aplicabilidad de estos indicadores mediante la creación de informes y explotación de los datos en el sistema de facturación de recetas del Servicio de Salud. RESULTADOS: Se localizaron 22 indicadores. El grupo de consenso seleccionó 16 indicadores. Once de ellos miden la selección específica de antimicrobianos y 5 son tasas de consumo. Los indicadores fueron aplicados satisfactoriamente a la base de datos de prescripción, pudiéndose realizar comparaciones entre distintas áreas geográficas y observar tendencias de prescripción. CONCLUSIÓN: Se requiere la definición de indicadores básicos de seguimiento de uso de antibióticos adaptados a la realidad local. Los resultados de estos indicadores pueden ser objeto de retroinformación a los profesionales y ser utilizados para evaluar el impacto de la implantación de programas de optimización de uso de antimicrobianos

OBJECTIVES: To determine core indicators for monitoring quality prescribing in Primary Care based on the evidence, and to assess the feasibility of these indicators for monitoring the use of antibiotics. METHODS: A literature review was carried out on quality indicators for antimicrobial prescribing through an electronic search limited to the period 2001-2012. It was completed with an "ad hoc" search on the websites of public national and international health services. Finally, indicators were chosen by consensus by a multidisciplinary group of professionals dedicated to managing infections from several areas. The feasibility and applicability of these indicators was verified through the reporting and use of data in the prescription database. RESULTS: Twenty two indicators were found. The consensus group selected 16 indicators. Eleven of them measure the specific antimicrobial selection, and 5 are consumption rates. The indicators were successfully applied to the prescription database, being able to make comparisons between different geographical areas and to observe trends in prescriptions. CONCLUSION: The definition of a basic set of indicators to monitor antibiotic use adapted to local conditions is required. The results of these indicators can be used for feedback to professionals and for evaluating the impact of programs aimed at improving antimicrobial use

[Selection of indicators for continuous monitoring of the impact of programs optimizing antimicrobial use in Primary Care]. / Selección de indicadores para la monitorización continua del impacto de programas de optimización de uso de antimicrobianos en Atención Primaria.

OBJECTIVES: To determine core indicators for monitoring quality prescribing in Primary Care based on the evidence, and to assess the feasibility of these indicators for monitoring the use of antibiotics. METHODS: A literature review was carried out on quality indicators for antimicrobial prescribing through an electronic search limited to the period 2001-2012. It was completed with an "ad hoc" search on the websites of public national and international health services. Finally, indicators were chosen by consensus by a multidisciplinary group of professionals dedicated to managing infections from several areas. The feasibility and applicability of these indicators was verified through the reporting and use of data in the prescription database. RESULTS: Twenty two indicators were found. The consensus group selected 16 indicators. Eleven of them measure the specific antimicrobial selection, and 5 are consumption rates. The indicators were successfully applied to the prescription database, being able to make comparisons between different geographical areas and to observe trends in prescriptions. CONCLUSION: The definition of a basic set of indicators to monitor antibiotic use adapted to local conditions is required. The results of these indicators can be used for feedback to professionals and for evaluating the impact of programs aimed at improving antimicrobial use.

Adecuación de la prescripción de antibióticos en un área de atención primaria: estudio descriptivo transversal / Appropriateness of antibiotic prescribing in a primary care area: A cross-sectional study

OBJETIVO: Analizar las características de la población que recibe tratamiento antibiótico y valorar la adecuación de estos tratamientos a sus indicaciones. MÉTODOS: DISEÑO: estudio descriptivo transversal de prescripción-indicación. EMPLAZAMIENTO: Un distrito de atención primaria en Andalucía. PARTICIPANTES: Pacientes adscritos a claves médicas del distrito. Se seleccionó una muestra por muestreo aleatorizado simple (nivel de confianza: 95%; precisión: 5%) de pacientes con prescripciones de antimicrobianos en 2009. Variable principal: adecuación de la prescripción de antibióticos a las recomendaciones de las guías locales. Los datos fueron obtenidos a través del sistema de facturación de recetas y la historia de salud digital. RESULTADOS: El 25% de la población del área recibió antibióticos durante 2009. La muestra (1.266 pacientes) presentó las siguientes características: el 57.9% eran mujeres, con una media de edad de 41 (± 1) años. El 39,3% eran pensionistas. La adecuación del tratamiento antibiótico fue del 19,9%, sin que se observaran diferencias de género. Se obtuvieron diferencias estadísticamente significativas relacionadas con la edad, y los mayores de 65años fueron el grupo de pacientes con mayor porcentaje de inadecuación. Los principales motivos de inadecuación fueron: no presentar registro de infección (44,5%), duración del tratamiento errónea (15,5%) y antibiótico incorrecto (11,5%). CONCLUSIÓN: Existe un alto grado de inadecuación en la prescripción de antibióticos en atención primaria. El alto grado de infra-registro, principalmente en pacientes de edades superiores, seguido de la utilización de pautas y tipo de antibióticos erróneos constituyen los principales motivos de inadecuación

OBJECTIVE: To assess the profile of patients receiving antibiotics and the appropriateness of these precriptions for the clinical conditions. METHODS: DESIGN: Cross-sectional study of prescription-indication. SETTING: A primary health care area in Andalusia. Subjects: Patients assigned to primary care centres. Patients with antibiotic prescriptions during 2009 were selected by simple random sampling (confidence level: 95%, accuracy: 5%). Primary endpoint: appropriateness of antibiotics prescribing to recommendations included in local guidelines. Data were obtained through the billing computerised prescriptions system and medical histories. RESULTS: Twenty-five per cent of the population area received antibiotics during 2009. The 1,266 patient samples showed the following characteristics: 57.9% were women, with a mean age of 41 (± 1) years. There were 39.3% pensioners. The percentage of appropriate antibiotic prescriptions was 19.9%, with no difference due to gender. Statistically significant differences were related to age, being those over 65 years the group of patients with the highest percentage of inappropriateness. The main reasons for inappropriateness were: no recording of the infectious process (44.5%), a wrong treatment duration (15.5%), and the use of an inadequate antibiotic (11.5%). CONCLUSION: There is a high level of inappropriateness in antibiotic prescribing in primary care. The high level of under-recording of diagnoses, mainly in elderly patients, followed by the use of wrong schedules, and the wrong type of antibiotics were the main reasons of inappropriateness

[Appropriateness of antibiotic prescribing in a primary care area: a cross-sectional study]. / Adecuación de la prescripción de antibióticos en un área de atención primaria: estudio descriptivo transversal.

OBJECTIVE: To assess the profile of patients receiving antibiotics and the appropriateness of these prescriptions for the clinical conditions. DESIGN: Cross-sectional study of prescription-indication. SETTING: A primary health care area in Andalusia. SUBJECTS: Patients assigned to primary care centres. Patients with antibiotic prescriptions during 2009 were selected by simple random sampling (confidence level: 95%, accuracy: 5%). Primary endpoint: appropriateness of antibiotics prescribing to recommendations included in local guidelines. Data were obtained through the billing computerised prescriptions system and medical histories. RESULTS: Twenty-five per cent of the population area received antibiotics during 2009. The 1,266 patient samples showed the following characteristics: 57.9% were women, with a mean age of 41 (±1) years. There were 39.3% pensioners. The percentage of appropriate antibiotic prescriptions was 19.9%, with no difference due to gender. Statistically significant differences were related to age, being those over 65 years the group of patients with the highest percentage of inappropriateness. The main reasons for inappropriateness were: no recording of the infectious process (44.5%), a wrong treatment duration (15.5%), and the use of an inadequate antibiotic (11.5%). CONCLUSION: There is a high level of inappropriateness in antibiotic prescribing in primary care. The high level of under-recording of diagnoses, mainly in elderly patients, followed by the use of wrong schedules, and the wrong type of antibiotics were the main reasons of inappropriateness.

Errores vacunales y situacionesque pueden conducir a erroresen Atención Primaria de salud / Vaccination errors and situations that may lead to mistakes in Primary Care

Objetivo: identificar errores en la administración de vacunas así como situacionesrelacionadas con la similitud de los envases que pudieran dar lugar a errores, enun distrito del Servicio Andaluz de Salud en el año 2007. Los resultados del estudiose utilizaron en una estrategia de difusión, tanto interna como externa.Material y método: estudio descriptivo en el Distrito Sanitario Aljarafe (Sevilla) delServicio Andaluz de Salud (SAS). Se recopiló la información sobre notificacionesde errores en la vacunación durante el año 2007. Se analizaron las similitudesen la denominación y etiquetado entre las vacunas disponibles en los centros.Resultados: se detectaron ocho errores reales por la administración de la vacunaantineumocócica 23-valente en lugar de la vacuna antigripal. Estos errores se debierona la gran similitud en el etiquetado. Se identificaron otros 15 situacionesque pueden conducir a errores relacionadas con el diseño y la denominación. Ladifusión interna se realizó mediante el envío de documentación a los responsablesde la gestión de vacunas en el Área y al Servicio Andaluz de Salud y mediantesesiones informativas para el equipo de Enfermería en los centros. Los errores vacunalesfueron notificados al Instituto para el Uso Seguro de los Medicamentos,que lo comunicó a la Agencia Española de Medicamentos y Productos Sanitariosy a los laboratorios fabricantes de las vacunas implicadas.Conclusiones: las vacunas constituyen un grupo de medicamentos con una alta probabilidadde conducir a errores de administración, relacionados en gran medidacon la similitud en la denominación y el etiquetado. Mientras no se adopten medidaspara diferenciarlas claramente, se requiere el esfuerzo de los profesionalesen la identificación correcta de los cartonajes para evitar errores en la administración (AU)

Objective: to identify errors in the administration of vaccines as well as errors thatcould be a result of similar packaging, in a district of the Andalusian Health Servicein 2007. The results of this study were used in both an internal and externaldissemination strategy.Material and method: descriptive study in the Health District of Aljarafe (Seville)of the Andalusian Health Service (AHS). Information regarding vaccination errorsreported in 2007 was gathered. Similarities in the names and labelling of the differentvaccines available in the centres were analyzed.Results: eight real errors were detected after the administration of the 23-valentantipneumococcic vaccine instead of the flu vaccine. These errors were due to thehighly similar labelling of both types of vaccine. 15 other situations which couldlead to errors related with design and name were identified. Internal disseminationwas carried out via the distribution of documentation to those in charge of vaccinemanagement in the Area and to the Andalusian Health Service and by meansof informative sessions for the Nursing team in these centres. Vaccination errorswere reported to the Institute for the Safe Use of Drugs, which in turn informedthe Spanish Drug and Healthcare Products Agency and laboratories which manufacturedthe vaccines involved.Conclusions: vaccines are a group of drugs presenting a high probability of leadingto administration errors due to their similarities in name and labelling. Untilmeasures are adopted to clearly differentiate them, professionals are required tobe careful in the correct identification of drug packages to avoid administrationerrors (AU)