Gaceta Sanitaria (Oct 2003)
Comparación de dos modelos de indicadores de la calidad de la prescripción farmacéutica en atención primaria Comparison of two models of prescription quality indicators in primary care
Abstract
Objetivo: Evaluar la calidad de prescripción en un área de atención primaria (AP) a partir de indicadores elaborados por los médicos de equipo y estudiar su relación con los indicadores de prescripción usados por el Insalud en el área. Métodos: Estudio de tipo observacional transversal. Se llevó a cabo en un área de AP de Asturias con 156.614 habitantes y 9 centros de salud. Se obtuvo una puntuación global de calidad para cada uno de los médicos de equipo de AP a partir de unos indicadores y estándares de calidad consensuados por los prescriptores. Se estudió la relación de la puntuación con los indicadores medidos de forma habitual en el área por el Insalud y con el gasto farmacéutico. Resultados: El promedio de cumplimiento del estándar óptimo se situó en un 29%. Se obtuvo un valor promedio para la puntuación global de calidad de 3,24. Ningún médico alcanzó la máxima puntuación de 11. No se encontró ninguna asociación significativa de la puntuación con el indicador de fármacos con utilidad terapéutica baja. La adhesión a la Guía Farmacoterapéutica del Área se correlacionó positivamente con la calidad (r = 0,44; p Objectives: To assess the quality of prescriptions in primary care area through indicators established by a team of physicians and to analyze the relationship between these indicators and those used by the Spanish public health system (INSALUD) in the same area. Methods: An observational, cross sectional study was performed in a primary care area in Asturias with 156,614 inhabitants and 9 health centers. An overall quality score was obtained for each of the physicians in the primary care area by using quality indicators and standards agreed on by the prescribers themselves. The relationship between the score obtained and the indicators normally used in the area by INSALUD and pharmaceutical cost was also analyzed. Results: Mean compliance with the optimal standard was 29%. The mean overall quality score was 3.24. None of the physicians achieved the maximum score of 11. No significant association was found between the score and the indicators for drugs of limited clinical value. Adherence to the pharmaceutical guide for the area was positively correlated with quality (r = 0.44, p < 0.001). A negative linear association (p < 0.001) was found between the overall quality score and incurred cost. The adjusted coefficient of determination was 0.29. Conclusions: Poor prescribing quality was widespread. Indicators for drugs of limited clinical value, frequently used as a measure of quality, showed no relationship with quality. Adherence to the area's pharmaceutical guide remains a valid indicator of prescribing quality. Overall, there was a correlation between higher quality and lower prescribing cost, although this correlation was not found for individual physicians.
