Effectiveness of the combination of feedback and educational recommendations for improving drug prescription in general practice
Effectiveness of the combination of feedback and educational recommendations for improving drug prescription in general practice
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DOI：
10.1097/01.mlr.0000129495.43422.58
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发表时间：
2004-07-01
期刊：
影响因子：
3
通讯作者：
Pérez-Rodríguez, MT
中科院分区：
文献类型：
--
作者：
Madridejos-Mora, R;Amado-Guirado, E;Pérez-Rodríguez, MT
背景资料：尽管人们对合理用药非常关注，但改善处方的最佳策略的现有证据却很少。目的：本研究的目的是评估个体化处方数据反馈和教育建议相结合对改善全科处方质量的有效性。方法：一个准实验干预研究进行了282个家庭医生的处方率干预前后进行了比较。分配到个性化的反馈组（n = 195）的医生收到个人的指令，具体的建议，根据他们的基线处方质量水平的改善，而在最小干预组（n = 87）的医生只收到标准的非个性化的处方数据的实践group作为一个整体。抗生素的过度处方在个体化反馈组中有所减少（P = 0.006），而在最小干预组中没有变化。使用非甾体类药物时，观察到各组中数值的不同趋势，但无统计学显著性。在个体化反馈组中，医生过度处方抗溃疡药物的情况有所减少（P = 0.003）;然而，与最小干预组相比，差异无统计学意义。个体化反馈组的药物选择指标变化更有利，但未观察到统计学显著差异。最小干预组的药品费用显著高于个体化反馈组，差异为7.87美元/人（P = 0.003）。结论：干预措施可以有效地提高处方质量，尤其是减少过度处方，并能显著降低药品费用。
Background: Although there is a great concern regarding rational use of drugs, the available evidence for the most appropriate strategies to improve prescribing is scarce.Goal: The goal of this study was to evaluate the effectiveness of the combination of feedback of individualized prescribing data and educational recommendations for improving the quality of prescribing in general practice.Method: A quasiexperimental intervention study was conducted in which prescribing rates of 282 family physicians before and after the intervention were compared. Physicians assigned to the individualized feedback group (n = 195) received individual instruction with specific recommendations for improvement according to their baseline prescribing quality levels, whereas physicians in the minimal intervention group (n = 87) only received standard nonindividualized prescribing data for the practice group as a whole.Results: A trend toward increasing high pharmacologic intrinsic value in both groups was observed. Overprescription of antibiotics showed a decrease in the individualized feedback group (P = 0.006) and it did not change in the minimal intervention group. A different trend in the values in each group was observed with nonsteroidal antiinflammatory drugs, although it was not statistically significant. Overprescription of antiulcerative agents decreased among physicians in the individualized feedback group (P = 0.003); however, there were not statistically significant differences as compared with the minimal intervention group. Changes in indicators of drug selection were more favorable for the group with individualized feedback, although no statistically significant differences were observed. Pharmaceutical expenditure increased significantly in the minimal intervention group as compared with the individualized feedback group, with an approximate difference of $7.87 per inhabitant and trimester (P = 0.003).Conclusion: The intervention showed that improving the quality of prescribing was feasible, particularly in overprescribing, and was associated with considerable savings in pharmaceutical costs.