RESUMO
OBJECTIVES: To assess whether electronic prescribing is a comprehensive health management tool that may contribute to rational drug use, particularly in polymedicated patients receiving 16 or more medications in the public healthcare system in the Barcelona Health Region (BHR). DESIGN: 16 months of retrospective study followed by 12 months of prospective monitoring. SETTING: Primary healthcare in BHR, Catalonia, Spain. PARTICIPANTS: All insured patients, especially those who are polymedicated in six basic health areas (BHA). Polymedicated patients were those with a consumption of ≥16 drugs/month. INTERVENTIONS: Monitoring demographic and consumption variables obtained from the records of prescriptions dispensed in pharmacies and charged to the public health system, as well as the resulting drug use indicators. Territorial variables related to implementation of electronic prescribing were also described and were obtained from the institutional data related to the deployment of the project. MAIN OUTCOME MEASURES: Trend in drug use indicators (number of prescriptions per polymedicated user, total cost per polymedicated user and total cost per prescription) according to e-prescription implementation. RESULTS: There was a significant upward trend in the number of polymedicated users, number of prescriptions and total cost (p<0.05), which seemed independent from the implementation of electronic prescribing when comparing the preimplementation and postimplementation period. Prescriptions per user and cost per user showed a decrease between the preimplementation and postimplementation period, being significant in two BHAs (p<0.05). CONCLUSIONS: Results suggest that after the implementation of electronic prescribing, the rationality of prescribing in polymedicated patients improved. In addition, this study provides a very valuable approach for future impact assessment.
Assuntos
Prescrição Eletrônica/estatística & dados numéricos , Polimedicação , Humanos , Estudos Longitudinais , Estudos Prospectivos , Projetos de Pesquisa , Estudos Retrospectivos , EspanhaRESUMO
OBJECTIVES: Polypharmacy is one of the main management issues in public health policies because of its financial impact and the increasing number of people involved. The polymedicated population according to their demographic and therapeutic profile and the cost for the public healthcare system were characterised. DESIGN: Cross-sectional study. SETTING: Primary healthcare in Barcelona Health Region, Catalonia, Spain (5 105 551 inhabitants registered). PARTICIPANTS: All insured polymedicated patients. Polymedicated patients were those with a consumption of ≥16 drugs/month. MAIN OUTCOMES MEASURES: The study variables were related to age, gender and medication intake obtained from the 2008 census and records of prescriptions dispensed in pharmacies and charged to the public health system. RESULTS: There were 36 880 polymedicated patients (women: 64.2%; average age: 74.5±10.9 years). The total number of prescriptions billed in 2008 was 2 266 830 (2 272 920 total package units). The most polymedicated group (up to 40% of the total prescriptions) was patients between 75 and 84 years old. The average number of prescriptions billed monthly per patient was 32±2, with an average cost of 452.7±27.5. The total cost of those prescriptions corresponded to 2% of the drug expenditure in Catalonia. The groups N, C, A, R and M represented 71.4% of the total number of drug package units dispensed to polymedicated patients. Great variability was found between the medication profiles of men and women, and between age groups; greater discrepancies were found in paediatric patients (5-14 years) and the elderly (≥65 years). CONCLUSIONS: This study provides essential information to take steps towards rational drug use and a structured approach in the polymedicated population in primary healthcare.
RESUMO
Electronic prescription is new advance in the use of new technologies on health care. It is a tool that increases quality health care, patient's accessibility and safety in use of drugs and sustainability of the system. Electronic prescription is also a system of prescribing and dispensing in real time, improving coordination between health professionals. The electronic prescription model establishes that the patient comes to the health center where physician diagnostics, makes prescriptions of treatment and, if it is necessary, gives a medication plan to the patient. This medication plan contains currents treatments and a security code. Patients can go to any pharmacy he wants and have to present medication plan and health care card for drug delivery. The electronic prescription is being implemented gradually in Catalonia; Barcelona city is the last zone where Electronic prescription is being implemented. On November, more than 3.100 physicians, 2.450 pharmacies and 870.000 patients are using electronic prescriptions normally and without any remarkable incidences and more than 90.000 drugs are being dispensed every day. Implementation of electronic prescription project is a success in Catalonia, with a good reception from professionals and patients. The model of electronic prescription improves every day to be more useful to professionals and patients.
Assuntos
Prescrição Eletrônica , Modelos Teóricos , EspanhaRESUMO
La receta electrónica supone un avance en el uso de las nuevas tecnologías en el ámbito de la salud. Es una herramienta de salud centrada en el paciente, que mejora la calidad asistencial, la accesibilidad a la prestación farmacéutica, la seguridad en el uso de los medicamentos y la sostenibilidad del sistema. Es un sistema de prescripción y dispensación en tiempo real, que mejora la coordinación entre profesionales sanitarios. El modelo establece que el paciente acude al centro de salud, donde el médico realizará el diagnóstico y, si es necesario, la prescripción de un tratamiento farmacéutico. Le entregará al paciente su plan de medicación, que contiene todos los tratamientos vigentes, y un código de seguridad. El paciente acudirá a la farmacia para que le sean dispensados los medicamentos prescritos, donde deberá entregar el plan de medicación y su tarjeta sanitaria individual. La receta electrónica se está desplegando progresivamente en Cataluña de forma conjunta entre todos los agentes. Actualmente, el proyecto está en su última fase, desplegándose en la ciudad de Barcelona, después de su implantación con éxito en el resto del territorio. A finales de noviembre, más de 3.100 médicos, 2.450 farmacias y 870.000 pacientes utilizan la receta electrónica con normalidad y sin incidencias remarcables, y se dispensan más de 90.000 medicamentos diariamente con receta electrónica. El proyecto de receta electrónica avanza con éxito en el territorio catalán, con buena aceptación de profesionales y pacientes. El modelo de receta electrónica está en constante evolución para introducir mejoras tanto para profesionales como pacientes (AU)
Electronic prescription is new advance in the use of new technologies on health care. It is a tool that increases quality health care, patients accessibility and safety in use of drugs and sustainability of the system. Electronic prescription is also a system of prescribing and dispensing in real time, improving coordination between health professionals. The electronic prescription model establishes that the patient comes to the health center where physician diagnostics, makes prescriptions of treatment and, if it is necessary, gives a medication plan to the patient. This medication plan contains currents treatments and a security code. Patients can go to any pharmacy he wants and have to present medication plan and health care card for drug delivery. The electronic prescription is being implemented gradually in Catalonia; Barcelona city is the last zone where Electronic prescription is being implemented. On November, more than 3.100 physicians, 2.450 pharmacies and 870.000 patients are using electronic prescriptions normally and without any remarkable incidences and more than 90.000 drugs are being dispensed every day. Implementation of electronic prescription project is a success in Catalonia, with a good reception from professionals and patients. The model of electronic prescription improves every day to be more useful to professionals and patients (AU)
