[Potential impact of measures to minimize drug costs in Aragon's primary care system]. / Impacto potencial de medidas de minimización de costes en la prestación farmacéutica en atención primaria de Aragón.

OBJECTIVE: To analyse the potential saving in pharmaceutical expenditure which the use of drug products of the same composition and lower price would suppose, by three high-consumption therapeutic sub-groups. DESIGN: Retrospective observation study. SETTING: Primary care. PARTICIPANTS: All the medical prescriptions of the doctors in the 121 primary care health districts in the three provinces of the Autonomous Community of Aragon during 1997, divided into the sub-groups: peptic ulcer (AO2B), lipid-lowering (B04A) and hypotensor drugs (C02). MEASUREMENTS AND MAIN RESULTS: Consumption, cost of treatment per day and potential saving of eight active principles belonging to these 3 sub-groups were calculated. Potential overall saving reached the figure of 972 million pesetas in Aragon in 1997. CONCLUSIONS: The alternative of prescribing drugs with an identical composition and lower price offers great potential savings in pharmaceutical expenditure, and may be a useful measure to improve the efficiency of health resources, and in particular those devoted to drug prescription.

[Minimizing the costs of prescription of anti-infective drugs in two areas of primary health care]. / Un estudio de minimización de costes en la prescripción de antiinfecciosos en dos areas de atención primaria.

BACKGROUND: Pharmaceutical costs are the main cost item in basic health care. The need to contain health care expenditure has led to the search for alternatives in this area, one of which would be to foster a prescription policy which uses the cheapest presentation for each active principle. The aim of this study was to evaluate the amount which would be saved by prescribing the cheapest alternative from a selection of anti-infective drugs. METHODS: Pharmacy prescriptions in two different health areas were analyzed using the database on turnover of pharmaceutical products for 1995. Single principle drugs with anti-infective action were selected, and for each active principle and presentation the most economic alternative was sought using the records provided by the Ministry of Health and a cost minimisation analysis was undertaken. The cost of applying this prescription policy was not considered. RESULTS: Total pharmaceutical expenditure in the areas was pesetas 8.547 bn in 1995. Expenditure on selected anti-infective drugs was pesetas 522 million (6.1% of the total). The overall saving estimated was 7.63% (pesetas 39,901,778). This saving was centred on the following subgroups: penicillins, quinolones, cephalosporins and macrolides. Of potential savings identified, 75% would be achieved by prescribing the cheaper alternative of 2 active principles: amoxacillin and cyprofloxacine. CONCLUSIONS: The study shows the possibility of containing expenditure in our area and offers a basis for action in this direction. It would be advisable to increase information and training for prescribers and dispensers in order to stimulate the use of the most economical alternative of each medicament prescribed, especially in cases in which there are significant margins to be saved.

[Are the indicators used to measure efficiency in primary care adequate?]. / Son adecuados los indicadores que se utilizan en atención primaria para medir la eficiencia?

OBJECTIVE: Getting to know the opinion of area managers and Primary Health Care Facilities coordinators about the indicators used to measure the PHC output. DESIGN: Questionnaire via mail. Descriptive statistics. SETTING: Areas 2-5, and 3, Zaragoza, Spain. PATIENTS: Managing teams of these three areas and Primary Health Care facilities coordinators. MEASUREMENTS AND MAIN RESULTS: The questionnaire was sent to 57 Primary Health Care Facilities coordinators and 16 area managers which was answered 53% of them. In the range from 1 to 10 the so-called product achieved in the evaluation the highest marks have been: the Services offered by the PHCF (7.8), Coverage (7.8), Achievement of the Minimal Technical Rules (7.76) and Patient Satisfaction (7.51). The indicator that obtained the highest level of agreement was also the product achieved in the evaluation of the Services offered by PHCF. CONCLUSIONS: According to these results indicators normally used, related with number of visits are questioned by the professionals. Synthetic indexes recently introduced obtained better values.

[Evaluation of the efficiency of primary care centers. Application of data analysis]. / Evaluación de la eficiencia en centros de atención primaria. Una aplicación del análisis envolvente de datos.

BACKGROUND: One of the major difficulties in evaluating the efficiency of Primary Medical Centres is that of integrating quantitative and qualitative data. METHODS: This study applies the Involved Data Analysis (DEA) for the purpose of evaluating the efficiency of Primary Medial Centres located in the Province of Zaragoza (Spain). DEA is a lineal programming technique that provides information on the relative efficiency of each unit, as compared to all other units. Output such as doctors and nursing services as well as variables relating to the quality of service, and input (personnel and pharmaceutical expenses) referring to 1994, were obtained from Area Management. RESULTS: Without taking qualitative variables into account, only 13 Primary Medical Centres reached maximum efficiency level 1. with a range of 0.53 to 1. Taking quality variables into account, 24 units reached optimum efficiency, with a range of 0.61 to 1. CONCLUSIONS: DEA is a useful tool for both qualitative and quantitative overall evaluation of input and output and identifies units that are inefficient as compared to others. Despite the difficulties involved, the method appears to be beneficial for management as a complementary aid to currently used techniques.

[Economic-health care indicators in 2 health areas: the cost of the "consultation product" of primary health teams]. / Indicadores económico-asistenciales en dos áreas sanitarias: el coste del "producto consulta" en equipos de atención primaria.

OBJECTIVE: To describe the main economic-healthcare indicators of Aragon Areas 2 and 5 in 1992. To quantify in economic terms the value of the medical and nursing consultations carried out by Primary Care teams. DESIGN: Cost-analysis type study (total costs). The criteria for attributing indirect costs were established by consensus. The data correspond to 1992 (real spending by each centre). The cost of the consultations was calculated in function of the overall activity undertaken and in line with the type of consultation. SETTING: Areas 2 and 5, Aragon. Calculation of the cost per consultation only for Primary Care teams (PCT). RESULTS: Spending per inhabitant and per year, both overall and broken down into care and pharmacy costs was 20,140 for PCT's (8,805 pesetas + 11,355 pes) and 23,153 pes for the traditional model (7,677 + 15,476 pes). Costs per consultation were: 1,031 pes for General Medicine plus 2,537 on Pharmacy; 1,765 pes for Paediatrics plus 716 on Pharmacy; 972 on nursing. Costs per consultation were also offered in function of the duration of each type of consultation and the health-care delivered. CONCLUSIONS: Overall, PCT's generated less expense per each insured person than the traditionally-based Consulting rooms. This situation is mainly due to Pharmacy costs, where the difference is over 4,000 pesetas. The evaluation of service costs in function of attendance supposes that, between two teams of equal composition and the same volume of spending, the more efficient will be that which produces the greater amount of services.