医院开处方者对全科医疗处方的影响。
The influence of hospital-based prescribers on prescribing in general practice.
作者信息
Feely J, Chan R, McManus J, O'Shea B
机构信息
Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland.
出版信息
Pharmacoeconomics. 1999 Aug;16(2):175-81. doi: 10.2165/00019053-199916020-00006.
OBJECTIVE
To document the influence of hospital prescribers on prescribing in general practice.
DESIGN AND PARTICIPANTS
Five percent of members of the Irish College of General Practitioners (n = 92) prospectively recorded 40 consecutive prescriptions.
INTERVENTIONS
The name, dose and amount of medicine prescribed as well as the indication for therapy, details of their practice, distribution of private/GMS patients, and the number of years since qualification were recorded. The cost of individual prescriptions was calculated based on the ingredient cost and the number of days of treatment. This was subsequently correlated with the origin of the prescription. Each prescription was classified as either new or repeat.
MAIN OUTCOME MEASURES AND RESULTS
Of 3286 prescriptions, 69% were for the state-supported General Medical Services (GMS) patients and 31% for private patients. Repeat prescriptions constituted 51%; 49% were new prescriptions. While hospital doctors initiated only 8% of private prescriptions, they initiated 38% of GMS prescriptions, particularly repeat prescriptions and those for cardiovascular, hormonal and centrally-acting agents. Prescriptions for anti-infectives, oral contraceptives, dermatological preparations and musculoskeletal drugs were mostly initiated in general practice. The median cost for hospital-initiated GMS prescriptions (5.93 Pounds) was greater than the cost of general practitioner (GP)-initiated prescriptions (3.49 Pounds; p < 0.01). Prescriptions from GPs who were qualified for less than 10 years and those with a mixed urban and rural practice were less costly (p < 0.05) than those issued by doctors qualified for over 10 years or working predominantly in an urban or rural area. These findings may also reflect differences in patient population, morbidity and demography.
CONCLUSIONS
Our study indicates that hospital-initiated prescriptions are responsible for a significant proportion, both in volume and cost of GP prescribing.
目的
记录医院开处方者对全科医疗处方的影响。
设计与参与者
爱尔兰全科医生学院5%的成员（n = 92）前瞻性地记录了连续40张处方。
干预措施
记录所开药物的名称、剂量和数量以及治疗指征、其执业细节、私人/政府资助医疗服务（GMS）患者的分布情况以及取得资格后的年数。根据成分成本和治疗天数计算每张处方的费用。随后将其与处方来源相关联。每张处方分为新处方或重复处方。
主要结局指标与结果
在3286张处方中，69%是为政府资助医疗服务患者开具的，31%是为私人患者开具的。重复处方占51%；49%是新处方。虽然医院医生仅开具了8%的私人处方，但他们开具了38%的政府资助医疗服务处方，尤其是重复处方以及心血管、激素和中枢作用药物的处方。抗感染药、口服避孕药、皮肤科制剂和肌肉骨骼药物的处方大多由全科医疗开具。医院开具的政府资助医疗服务处方的中位数成本（5.93英镑）高于全科医生（GP）开具处方的成本（3.49英镑；p < 0.01）。取得资格少于10年的全科医生以及既有城市又有农村执业经历的全科医生开具的处方成本低于取得资格超过10年或主要在城市或农村地区工作的医生开具的处方（p < 0.05）。这些发现也可能反映了患者群体、发病率和人口统计学方面的差异。
结论
我们的研究表明，医院开具的处方在全科医生处方的数量和成本方面都占很大比例。
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