The quality of pharmacologic care for adults in the United States
The quality of pharmacologic care for adults in the United States
复制标题
DOI：
10.1097/01.mlr.0000223460.60033.79
复制
发表时间：
2006-10-01
期刊：
影响因子：
3
通讯作者：
McGlynn, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Shrank, William H.;Asch, Steven M.;McGlynn, Elizabeth A.
背景资料：尽管处方药的年度支出不断增加，但关于美国成人药理学护理质量的系统信息却很少。我们评估了如何经常适当的药理学护理订购在一个国家样本的U.S. resident.Methods：兰德/加州大学洛杉矶分校修改德尔菲过程中被用来选择质量的护理指标为成人在30个慢性和急性疾病和预防保健。确定了133项药理学护理质量指标。我们通过电话随机采访了居住在美国12个大都市地区的成年人，并获得了他们最近2年的医疗记录副本。我们提取了患者的医疗记录，并评估了处方过程的4个领域，包括整个药理学护理经验：适当的药物处方（使用不足），避免不适当的药物（过度使用），药物监测，药物教育和文件。共有3457名参与者符合至少1项质量指标，评价了10,739起合格事件。我们构建了总得分，并研究了患者，保险和社区因素是否影响quality.Results：参与者接受了61.9%的推荐药物治疗整体（95%置信区间60.3-63.5%）。教育和记录方面的表现最低（46.2%）;药物监测（54.7%）和适当药物使用不足（62.6%）表现较高。避免不适当药物的表现最好（83.5%）。患者的种族和卫生服务利用率与适度的质量差异，而保险状态not.Conclusions：在美国的成年人中，药理学护理的质量显着赤字，与适当的药物使用不足相关的大的不足。应该考虑衡量和提高药理学护理质量的策略，特别是当我们开始为老年人提供处方药福利时。
Background: Despite rising annual expenditures for prescription drugs, little systematic information is available concerning the quality of pharmacologic care for adults in the United States. We evaluated how frequently appropriate pharmacologic care is ordered in a national sample of U.S. residents.Methods: The RAND/UCLA Modified Delphi process was used to select quality-of-care indicators for adults across 30 chronic and acute conditions and preventive care. One hundred thirty-three pharmacologic quality-of-care indicators were identified. We interviewed a random sample of adults living in 12 metropolitan areas in the United States by telephone and received consent to obtain copies of their medical records for the most recent 2-year period. We abstracted patient medical records and evaluated 4 domains of the prescribing process that encompassed the entire pharmacologic care experience: appropriate medication prescribing (underuse), avoidance of inappropriate medications (overuse), medication monitoring, and medication education and documentation. A total of 3457 participants were eligible for at least 1 quality indicator, and 10,739 eligible events were evaluated. We constructed aggregate scores and studied whether patient, insurance, and community factors impact quality.Results: Participants received 61.9% of recommended pharmacologic care overall (95% confidence interval 60.3-63.5%). Performance was lowest in education and documentation (46.2%); medication monitoring (54.7%) and under-use of appropriate medications (62.6%) performance were higher. Performance was best for avoiding inappropriate medications (83.5%). Patient race and health services utilization were associated with modest quality differences, while insurance status was not.Conclusions: Significant deficits in the quality of pharmacologic care were seen for adults in the United States, with large shortfalls associated with underuse of appropriate medications. Strategies to measure and improve phannacologic care quality ought to be considered, especially as we initiate a prescription drug benefit for seniors.