An epidemiologic approach to drug prescribing quality assessment - A study in primary care practice in France

被引:34
作者
Coste, J [1 ]
Venot, A [1 ]
机构
[1] Univ Paris, Dept Biostatist & Informat Med, Fac Cochin, F-75674 Paris 14, France
关键词
drug; prescribing; quality; epidemiology; health care;
D O I
10.1097/00005650-199912000-00012
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
OBJECTIVE. TO assess drug prescribing by primary care physicians in France far various types of conditions, and to identity patterns and risk factors for poor prescribing quality. METHODS. The orders (n = 23,080) written for patients with five target diseases (acute nasopharyngitis, acute tonsillitis, essential hypertension, osteoarthrosis, and back and periarticular disorders), by primary care physicians (n = 1,049) were extracted from a nationwide prescription database and analyzed according to 17 quantitative indicators of: drug prescribing quality constructed on explicit a priori criteria. RESULTS. Ineffective drugs were prescribed in 32% to 88% of orders according to the target disease. Six percent to 40% of orders resulted in drug interactions, age problems, and overdosage. A consistent pattern of associations between indicators was found, which suggests that drug prescribing quality is multidimensional and is composed of at least five dimensions: placebo, novelty, exoticism, misdosage, and interaction. Several factors associated with indicators were also identified, some of them defining groups of patients at risk (women, elderly, and less educated), physicians at risk (women, aged, and isolated), and contexts at risk (patient's home and disease frequently treated by the physician) of poor drug prescribing quality. CONCLUSIONS. Drug prescribing by French primary care physicians appears nonoptimal, in terms of both risk of iatrogeny and waste of money. This study further documents the complexity and the multidimensionality of drug prescribing quality. It suggests that more attention must be paid to patients' and physicians' risk factors for poor drug prescribing quality if educational programs and regulatory processes are to succeed in promoting safer and more cost-effective practices.
引用
收藏
页码:1294 / 1307
页数:14
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