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      Seleccion de indicadores para evaluar la adhesión a una guia farmacoterapéutica por los médicos generales de un área de atención primaria Translated title: Set of indicators for assessing the degree to which a drug therapy guide is followed in a primary care area

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          Abstract

          Fundamento: La medida continuada de la calidad de la prescripción farmacéutica forma parte de los programas de mejora de calidad de procesos asistenciales sanitarios en Atención Primaria, pero, en general, se carece de indicadores validados que puedan utilizarse para realizar dicho proceso de evaluación. La medida de la adhesión a una selección de fármacos determinada, como una guía de área consensuada, puede utilizarse como indicador global de la calidad de prescripción. El objetivo del trabajo ha sido el establecimiento de un método para seleccionar indicadores de calidad de tipo globalizador, ejemplificando el mismo en selección de un indicador para medir la adhesión a la guía de área. Métodos: Estudio descriptivo transversal utilizando como unidad de análisis los médicos generales del Área Sanitaria de Avilés (n=78) y como fuente de información las recetas facturadas de los mismos durante 1997. Se elaboraron 7 indicadores para medir la adhesión a la Guía Farmacoterapéutica del Área. Se realizó una selección estudiando las siguientes características: fiabilidad, facilidad de obtención, precisión, sensibilidad, especificidad y coherencia. Resultados: Las puntuaciones obtenidas oscilaron entre 10 y 23 (sobre un máximo posible de 28), siendo el valor más alto el correspondiente al porcentaje de recetas de principios activos de la guía con respecto al total de recetas prescritas por cada facultativo. Conclusiones: Los indicadores utilizados en la evaluación de la calidad farmacológica deben analizarse de un modo detallado previamente a su implantación. Se propone un método innovador para realizar la validación de indicadores de monitorización de la prescripción farmacéutica de tipo globalizador. De los indicadores estudiados para la medida de la adhesión a la guía farmacéutica de Atención Primaria el más útil es el porcentaje de recetas de los principios activos de la misma respecto al total de recetas prescritas. La adhesión a la Guía Farmacológica del Área se relaciona positivamente con una prescripción de calidad.

          Translated abstract

          Background: The constant gauging of drug prescription quality is part of the health-care process quality improvement programs as regards Primary Care, but, generally speaking, there are no tried and true indicators which can be used in this assessment process. Measuring the degree to which certain set drugs are adhered to as a district-wide guide regarding which a consensus of opinion has been reached can be used as an overall indicator of prescribing-related quality. The objective of this study is that of setting out a method for selecting quality indicators of a generalizing type, the same serving as an example with regard to selecting an indicator for gauging the degree to which the district guide is followed. Methods: Descriptive cross-sectional study entailing the general practitioners in the Health Care District of Avilés (n=78) as the individual district analyzed, and the prescriptions written thereby which were invoiced in 1997 as the data source. Seven (7) indicators were prepared for gauging the degree to which the District Drug Therapy Guide was followed. A selection was made by studying the following aspects: reliability, ready availability, accuracy, sensitivity, specificity and coherence. Results: The scores fell within the 10-23 range (out of a possible 28), the highest score being that of the percentage of prescriptions for active ingredients out of the guide in comparison to the total number of prescriptions written by each physician. Conclusions: The indicators used in assessing drug-prescribing quality must first be analyzed in detail before being implemented. An innovative method is suggested for testing indicators for monitoring the prescribing of drugs as a whole. The most useful of all of the indicators studied for gauging the degree to which the Primary Care drug therapy guide was being followed is the percentage of prescriptions written for active ingredients out of the total number of prescriptions written. The degree to which the District Drug Therapy Guide is followed is related positively to quality prescribing.

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          General practice fundholding: observations on prescribing patterns and costs using the defined daily dose method.

          To compare prescribing patterns between a group of fundholding practices and a group of non-fundholding practices in north east Scotland using a method which provides more accurate statements about volumes prescribed than standard NHS statistics. The pharmacy practice division of the National Health Service in Scotland provided data for selected British National Formulary sections over two years. Each prescription issued was converted using the World Health Organisation "defined daily dose" mechanism. Six fundholding groups (nine practices) in Grampian and Tayside regions and six non-fundholding practices in Grampian. During the past two years both fundholding and control practices reduced the volume of their prescribing for the classes of drug analysed. The unit costs of drugs in some classes, however, rose substantially, contributing to higher costs per patient. The unit costs rose more in the control practices (24%) than in the fundholding practices (11% in Tayside, 16% in Grampian). The use of defined daily doses helped identify cost and volume trends in specific areas of prescribing in fundholding and control practices. The basis on which funds are set needs improving, and defined daily doses may prove useful for setting volume targets within drug classes for all practices, whether fundholding or not.
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            Drug formularies: myths-in-formation.

            Drug formularies are pivotal tools for delineating and directing prescribing to the "drugs of choice." Full realization of their potential has been hampered by insufficient comparative data on drug efficacy/safety and local resources for formulary development. However, misconceptions concerning fundamental formulary concepts pose an even more formidable obstacle. This article identifies statements illustrating formulary misconception a) made by physicians attending Pharmacy and Therapeutics Committee meetings during a three-year period and b) appearing in published sources. The paper highlights basic objectives and operational requirements of an effective formulary, and contrasts this definition with 20 myths and misinformation culled from these two sources. Not only does such misinformation impair formulary development, many critics are so preoccupied with alleged shortcomings that progress in minimizing the real limitations of formularies has been impeded.
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              Changing to generic formulary: how one fundholding practice reduced prescribing costs.

              To observe one general practice's attempt to reduce prescribing costs on becoming third wave fundholders through the introduction of a generic formulary applied to all new and repeat prescribing. To assess the impact on patients and prescribing patterns. An observational study using interviews with patients and practitioners; questionnaires for patients and prescribing data. One urban general practice with five partners in Scotland. It became fundholding in April 1993. 71 searches of the register of repeat prescriptions identified 1274 potential changes in drugs. Questionnaires were sent to a stratified random sample of 280 patients four months after the changes were made; 33 interviews were conducted with 17 patients selected by local pharmacists to represent a wide range of opinion. Changes in prescribing and response and satisfaction of patients. Of intended changes, 129 (70%) were in place after four months. Thirty three (20%) of the 167 patients who returned questionnaires were "very unhappy," though interviews suggested that this was primarily with the communication they received rather than the change itself. Generic prescribing rose from one in three (37%) to over a half (58%). The volume of treatment dispensed (as treatment days) fell by 67,674 (10.7%), and the average cost per day's treatment fell by 3.1 p from 32.3 p per day in 1992 (9.4%), producing a total absolute saving of 24% (137,712 pounds) over the first year. This practice has achieved a large reduction in prescribing costs rapidly. These were tolerated by patients, none of whom is thought to have left the practice for this reason. Great care must be taken to inform patients appropriately.
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                Author and article information

                Journal
                resp
                Revista Española de Salud Pública
                Rev. Esp. Salud Publica
                Ministerio de Sanidad, Consumo y Bienestar social (Madrid, Madrid, Spain )
                1135-5727
                2173-9110
                February 2000
                : 74
                : 1
                Affiliations
                [01] orgnameInsalud orgdiv1 Gerencia de Atención Primaria del Área Sanitaria III
                [02] orgnameInsalud orgdiv1 Subdirección General de Atención Primaria
                Article
                S1135-57272000000100008 S1135-5727(00)07400100008
                10.1590/s1135-57272000000100008
                425c4078-5069-4033-a9b4-e3a598aa83d4

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

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                Guía Farmacoterapéutica,Assessment methodology,Quality indicators,Quality Control,Medications,Prescribing,Primary Care,Form,Drug Therapy Guide,Sistemas de información,Evalución,Indicadores de calidad,Control de calidad,Uso de medicamentos,Prescripción,Atención primaria,Formulario

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