ABSTRACT
OBJECTIVES: The computer system for billing prescriptions (SIFAR in Spanish) enables indicators to be extracted for the study and follow-up of the use of medicines in the INSALUD primary care areas. Concretely, we studied the indicator referring to pensioners consumption of lipid-lowering drugs (PCLL), not validated, and whose value is expected to drop as quality increases. The objective was to calculate the correlation of the indicator of prescription of lipid-lowering drugs on the SIFAR with the proportion of lipid-lowerers prescribed correctly for pensioners (PCP). DESIGN: A descriptive study of correlation between two indicators of drug prescription. SETTING: Four health districts in Madrid. PARTICIPANTS: The prescriptions of 49 general practitioners, chosen at random on the basis of three strata defined by the value of the indicator, were studied. Each doctor filled out a protocol of data for each pensioner patient to whom he/she prescribed a lipid-lowerer during the study period. MEASUREMENTS AND MAIN RESULTS: The PCLL and PCP indicators were compared through the correlation of Spearman. 6,779 prescriptions for 1,125 patients were collected from the 49 participating doctors. The mean percentage of lipid-lowerers correctly prescribed was 31.9%, figure that rose to 77.5% when the LDL value was not specified. The correlation between the PCLL and the PCP was near zero. CONCLUSIONS: The PCLL indicator of the SIFAR does not discriminate quality in lipid-lowering drug prescription to people over 64.
Subject(s)
Drug Prescriptions/standards , Family Practice/standards , Hyperlipidemias/drug therapy , Quality Indicators, Health Care , Aged , Drug Utilization/standards , Drug Utilization/statistics & numerical data , Humans , Middle Aged , Reproducibility of Results , SpainABSTRACT
Objetivos. El sistema informático de facturación de recetas (SIFAR) permite la obtención de indicadores para el estudio y seguimiento de la utilización de medicamentos en las áreas de atención primaria del INSALUD. Concretamente, estudiamos el indicador referido al consumo de hipolipemiantes en población pensionista (CHPP), no validado y cuyo valor es esperable que disminuya al incrementarse la calidad. El objetivo es estimar la correlación del indicador de prescripción de hipolipemiantes del SIFAR con el porcentaje de hipolipemiantes correctamente prescritos en pensionistas (PCP). Diseño. Estudio descriptivo de correlación entre 2 indicadores de prescripción farmacológica. Emplazamiento. Cuatro áreas de salud de Madrid. Participantes. Se estudian las prescripciones de 49 médicos generales, elegidos aleatoriamente a partir de 3 estratos definidos por el valor del indicador. Cada médico rellena un protocolo de datos por cada paciente pensionista al que prescribe un hipolipemiante durante el período del estudio. Mediciones y resultados principales. Se comparan los indicadores CHPP y PCP mediante correlación de Spearman. Se han recogido 6.779 prescripciones correspondientes a 1.125 pacientes de los 49 médicos que participaron. El porcentaje medio de envases de hipolipemiantes correctamente prescritos es del 31,9 por ciento, cifra que asciende al 77,5 por ciento si no se exige tener constancia del valor LDL. Las correlaciones obtenidas entre el CHPP y el PCP son cercanas a cero. Conclusiones. El indicador CHPP del SIFAR no discrimina la calidad de prescripción de hipolipemiantes en mayores de 64 años (AU)
Subject(s)
Middle Aged , Aged , Humans , Quality Indicators, Health Care , Spain , Reproducibility of Results , Drug Prescriptions , Drug Utilization , Hyperlipidemias , Family PracticeABSTRACT
OBJECTIVE: To examine if the treatment with alendronate to prevent hip fracture (HF) in female with established osteoporosis is more cost-effectiveness than placebo, and if changes in efficacy, cost and incidence of adverse reactions of the treatment can affect the ratio, and the direction of decision. DESIGN: The study is based on a decision tree model to examine the cost-effectiveness ratio (CE) of alendronate (10 mg/d alendronate, 500 mg/d calcium and 250 IU vitamin D3) versus placebo (500 mg/d calcium and 250 IU vitamin D3). The treatment of 1000 patients with established osteoporosis and its course of events and probabilities during three years of treatment is simulated. RESULTS: The efficacy of each alternative is obtained by controlled clinical trials. The considered costs, from the first perspective of the services provider, and expressed in pesetas per year in 1998, are direct health tangibles: pharmacological treatment, HF surgery and treatment of serious adverse reactions (SAR). An analysis of simple univariate sensibility and one of incremental is applied on the efficacy, cost and incidence of adverse reactions to alendronate. The ratio CE of alendronate is 297.879 pesetas/success (patient without fracture and without SAR) and 23.301 pesetas/success for placebo. For the hypothesis of a 100% alendronate efficacy, the ratio CE is 287.217 pesetas/success and without SAR is 297.830 pesetas/success. A cost of 210 pesetas/alendronate box will determine that this alternative is as cost-effective as placebo. CONCLUSIONS: The administration of alendronate to prevent HF on postmenopausal female with established osteoporosis is not the option to take into account. Just a decrease of the cost of alendronate below its crossing value will turn it into a cost-effective alternative.
Subject(s)
Alendronate/economics , Hip Fractures/prevention & control , Aged , Alendronate/adverse effects , Alendronate/therapeutic use , Cost-Benefit Analysis , Decision Support Techniques , Female , Hip Fractures/economics , Hip Fractures/surgery , Humans , Middle Aged , Osteoporosis, Postmenopausal/complications , Osteoporosis, Postmenopausal/drug therapy , Osteoporosis, Postmenopausal/economics , Placebos , Sensitivity and SpecificityABSTRACT
OBJECTIVE: To describe the introduction of a medicine information programme by the Pharmacy Service and to evaluate this programme, analysing the usefulness of the information supplied. SETTING: "12 de Octubre" University Hospital, Health Area 11, Madrid. PATIENTS: Patients discharged by the Internal Medicine Service over a six-month period, with patients with HIV or palliative treatment being excluded. INTERVENTIONS: On their hospital discharge, patients were informed orally and in writing on the medicine's dosage, action and side-effects, as well as general considerations during treatment. After 30 days the patients concerned were polled by telephone. RESULTS: Information was supplied to 163 patients. The average number of medicines prescribed on discharge was 4.6. Average age was 65 +/- 15 years. 141 patients were interviewed. 8.5% did not answer the telephone interview. 90.8% consulted the written information received and 10% had difficulty in understanding them. 77% wished to receive oral and written information. 95% found the information useful. When questioned on the number of medicines they took, 88.6% of the patients gave a reply which coincided with the medicines prescribed on discharge. 88.4% understood the indication of the treatment and 35% remembered the commercial names. 93% knew the intervals between doses and 76% knew what to do if they forgot a dose. CONCLUSIONS: In the group of patients under study, a high demand for information on medication was identified. The great majority considered useful the information provided by the Pharmacy Service.
