[Spanish adaptation of Beers criteria]. / Adaptación española de los criterios Beers.

BACKGROUND: The Beers criteria, which were drawn up in the USA and updated in 2012, were developed to detect potentially inappropriate prescriptions in older adults. Since there are significant differences between the Spanish and North American drug catalogues, our aim was to produce a Spanish adaptation of the criteria. PATIENTS AND METHODS: A comparison of the drugs mentioned in the Beers list with the 2012 Spanish Drugs Catalogue identified those active substances that were on the list in the USA but not commercially available in Spain. We also searched for Spanish drugs that were similar to those listed in the criteria. If these drugs were available in the USA, it was assumed that they had been evaluated by the Beers authors. On the other hand, if similar active substances were not available in the USA, they were evaluated by reference to three information sources: articles reviewed by the American Geriatrics Society in support of the Beers criteria, the product characteristics and information leaflets, and the European STOPP/START, NORGEP and PRISCUS criteria. RESULTS: Of the 199 active substances listed in the Beers criteria, 54 (27.0%) were not commercially available in Spain, but 50 new active substances could be included. These figures differed when "Direct Criteria" were considered: 47 (34.3%) active substances were not commercially available in Spain and 40 new ones could be included in the Beers list. As regards "Disease Dependent Criteria" the figures were 33 (21.3%) and 48, respectively. CONCLUSIONS: A great number of drugs on the Beers list were not commercially available in Spain, and we added many active substances not included in the original version. This study is thus an adaptation of the Beers Criteria to the Spanish health care scenario.

[Effectiveness of an intervention to improve medical prescription quality in specialized care]. / Efectividad de una intervención en la mejora de la calidad de prescripción con receta médica en atención especializada.

OBJECTIVE: The study was designed to research whether providing doctors with customized reports on prescription indicators,plus a presentation of the project to clinical departments and hospital boards, would improve prescription quality in specialized care. MATERIAL AND METHODS: Quasi experimental intervention study. During three periods of time we observed whether any differences between physicians receiving said reports (intervention group) and physicians not receiving said reports (control group)occurred in three overall quality markers (94 physicians)--generic drugs, low therapeutic value drugs, and irrelevant novel drugs-and two specific indicators--angiotensin converting enzyme inhibitors (109 physicians) and omeprazole (169 physicians). Indicators were assessed using mean values (95% Cl) and differences between groups with the z test. RESULTS: Prior to the intervention, indicators had no significant differences. At 4-6 months after delivering the report, generic drug prescription improved in the intervention group - 3.13%(1.79-4.47) versus 1.81% (1.08-2.54) in the control group,p = 0.041. After 10-12 months the intervention group had significantly improved versus the control group regarding: generic drugs, 4.01% (2.28-5.73) versus 2.22% (1.56-2.87), p = 0.025;ACE inhibitors, 58.89% (47.56-70.21) versus 45.91% (36.03-55.79), p = 0.042; and low therapeutic utility drugs, 8.57%(5.56-11.6) versus 12.35% (8.96-15.74), p = 0.047. Improvement regarding omeprazole did not reach statistical significance,and novel medications remained virtually unchanged. CONCLUSION: The intervention proved effective for the improvement of qualitative prescription indicators in specialized care.

[Prescription of drugs in family medicine: on the trail of efficiency]. / Prescripción de medicamentos en medicina de familia: tras las pistas de la eficiencia.

OBJECTIVE: To analyse the effect of various factors on the efficiency of drug prescription by general practitioners (GPs). DESIGN: Descriptive, cross-sectional study. SETTING: Primary care in Murcia, Cartagena, and Lorca, in which 535 GPs work in the care of 921,281 people. Murcia Region (Spain).Participants. Prescriptions issued by the 288 GPs who were working constantly and continuously in May-June 1998 and who were away from work for no longer than 10% of the time (53.8%). MAIN MEASUREMENTS: We measured their efficiency with two general indicators--potential saving (PS) and prescription of generics (PG)--and 3 specific indicators: efficiency of prescription of omeprazole (EO), enalapril (EE), and ranitidine (ER). We analysed their relationship with structural-organisational factors and with the population attended, the doctor and his/her action. Bivariate and multivariate analyses (logistic regression) were used. RESULTS: There was an association with programmed consultation (PC); a weak inverse relationship with age of doctor, years qualified, pensioners allocated, case load and inter-consultations conducted; and a direct correlation with the length of the consultation. PG was related to rural environment, being non-permanent, specialist in family medicine, belonging to a primary care team. In the multivariate analysis PC was related to all the indicators: PS (OR=1.96), PG (OR=2.10), EO (OR=2.63), ER (OR=2.84), EE (OR=2.06); and the inter-consultations conducted with general efficiency of PS (OR=1.70), PG (OR=1.91). Rural environment was the worst for PS (OR=2.43). CONCLUSIONS: The main factors related to the efficiency of GPs prescription can be changed. The most important is the existence of PC. A lot of inter-consultations and working in a rural environment means worse general efficiency.

Utilización de antihipertensivosen Atención Primaria / Antihypertensive drug use in Primary Health Care

Objetivo. Analizar el uso de antihipertensivos en Atención Primaria en el período comprendido entre 1999 y 2001 y valorar la introducción de los antagonistas de los receptores de la angiotensina II (ARA-II).Métodos. Estudio observacional retrospectivo. Se seleccionaron todas las prescripciones de antihipertensivos mediante recetas de la Seguridad Social en la gerencia de Atención Primaria de Murcia. Las fuentes de datos fueron las cintas de facturación mensual de recetas de la Seguridad Social, nomenclator digitalis de noviembre de 2001, bases de datos de médicos y población con tarjeta sanitaria. Los resultados se expresan en dosis diaria definida (DDD) por 1.000 habitantes y día (DHD).Resultados. El consumo de antihipertensivos se incrementó de 161,7 DHD en 1999 a 183,22 en 2001 (13,3 por ciento).Las prescripciones de antihipertensivos supusieron el 11,67 por ciento del total de recetas. Los fármacos más utilizados fueron los inhibidores de la enzima de conversión de la angiotensina (IECA) (28 por ciento de las DHD totales) y los de mayor crecimiento los ARA-II (incremento del 108 por ciento).Aunque en 2001 los IECA duplicaron a los ARA-II en DHD, el consumo por precio de venta al público (PVP) fue prácticamente el mismo. El uso de diuréticos y betabloqueantes fue del 12,3 por ciento y 8,8 por ciento, respectivamente, en DHD. El fármaco más consumido en todo el período fue enalapril, seguido a distancia por amlodipino, captopril, atenolol y valsartán en 2001.Conclusiones. Los antihipertensivos mantienen una tendencia ascendente de consumo determinada por el incremento de ARA-II. Los IECA continúan siendo los más prescritos y los diuréticos y betabloqueantes probablemente estén infrautilizados. El incremento de ARA-II ha originado un cambio cualitativo en la terapéutica antihipertensiva: se ha detenido la tendencia ascendente de los IECA y se ha incrementado el coste del tratamiento. (AU)

Efectividad de un sistema de información personalizada sobre la calidad de prescripción de medicamentos en médicos de familia / Effectiveness of a personalised information system on the quality of family doctors' medical prescription

Objetivo. Evaluar la efectividad de un sistema de información personalizada de prescripción (IPP) en la mejora de los hábitos de prescripción de los médicos de familia (MF); conocer su utilidad para mantener estos hábitos, y analizar su influencia por factores del médico y su entorno. Diseño. Estudio descriptivo, transversal, previo para analizar factores condicionantes y de confusión; estudio de intervención cuasiexperimental para valorar la efectividad del IPP, con 2 grupos (experimental y control) y 4 determinaciones (antes del IPP y después: corto, medio y largo plazo).Emplazamiento. MF de la Región de Murcia. Sujetos de estudio. Prescripciones de todos los MF de la Región de Murcia existentes antes del IPP, que continúan hasta finalizar el estudio y sin ausencias superiores al 10 por ciento en cada medición. Formación de los grupos. Intervención: los MF de la Gerencia de Murcia formarán el grupo experimental; reciben el IPP con propuestas específicas de mejora. Los MF de Cartagena y Lorca no reciben el IPP y constituyen el grupo control. Análisis estadístico. Regresión logística para identificar factores condicionantes. Z de comparación de proporciones con contraste de hipótesis unilateral para comprobar la efectividad del IPP. Limitaciones del diseño. La no asignación aleatoria de los grupos dificulta su comparabilidad: se estudian factores condicionantes para estratificación o ajuste. Aplicabilidad práctica. Confirmar la efectividad del IPP justifica su difusión. No hacerlo obligará a perfeccionarlo. Aislar factores modificables condicionantes de la prescripción ayuda a actuar para mejorar (AU)