Mengíber Torres F J
17712
Gac Sanit. 2000 Jul-Aug;14(4):277-86. doi: 10.1016/s0213-9111(00)71477-4.
To determine the influence on drug expenditures by reformed primary care services of factors relative to the personal characteristics of prescribers, their training and training activities, their professional practice, organizational factors, and characteristics of the patient population attended.
This cross-sectional, observational study was carried out in the Sabadell Primary Care Directorate, Vallés Occidental region (Barcelona, Spain). This primary care directorate is responsible for the health-care needs of 9 municipalities (with a total population of 254,971 inhabitants). It has 12 Basic Health Areas, 8 of which have Primary Care Teams. The area of study included these 8 primary care teams and the unit of analysis contained 68 of 80 staff physicians. The quantitative prescription indicators (dependent variables) were: total annual drug expenditure, drug expenditure per user and year (users being understood as patients with an open medical record), drug expenditure per visit and year, mean cost per prescription, prescription/user ratio, and prescription/visit ratio. Descriptive, bivariate, and multiple linear regression analyses were made.
The variables predictive of greater drug expenditures were: patient age, visits, frequentation, referrals to primary-care specialists, urban municipality, physicians with primary care and hospital practice, time on staff, and physician age. Participation in training activities was predictive of drug savings, with each primary-care training session attended producing a mean annual savings in drug expenditures of 50 ptas and 15 ptas per user and visit, respectively. Every hour dedicated to training in the community produced a savings of almost 60,000 ptas in annual drug expenditures. For each rational-drug-use session, the mean price of prescriptions decreased by 52 ptas. In the multiple linear regression models obtained, the variables that most frequently helped to explain variations between prescribers in relation to drug expenditures were: patient age, urban municipality, and primary-care-team training activities (as factors in drug savings).
This study confirmed that patient age, frequentation, and type of municipality increased drug expenditures. Urban municipalities, as opposed to rural or semirural municipalities, were associated with a significantly greater expense, in contrast with prevailing opinion. Our results suggested that drug expenditures increase with referrals to specialists. An interesting new finding is that physicians with simultaneous primary care and hospital practice generated more drug expenditures. Finally, we emphasize the importance of training the primary-care team in promoting drug savings (four models: drug expenditures by users, drug expenditures per visit, prescriptions per user, and prescriptions per visit), rational-drug-use activities, which tended to reduce the mean cost of prescriptions, and community training activities, which clearly reduced annual total drug expenditures.
确定相对于开处方者的个人特征、其培训及培训活动、其专业实践、组织因素以及所服务患者群体的特征而言，基层医疗服务改革对药物支出的影响。
这项横断面观察性研究在西班牙巴塞罗那西部瓦列斯地区的萨瓦德尔基层医疗管理局开展。该基层医疗管理局负责9个市镇（总人口254,971居民）的医疗保健需求。它有12个基本健康区，其中8个有基层医疗团队。研究区域包括这8个基层医疗团队，分析单位包含80名在职医生中的68名。定量处方指标（因变量）为：年度药物总支出、每位使用者每年的药物支出（使用者被理解为有开放病历的患者）、每次就诊每年的药物支出、每张处方的平均费用、处方/使用者比率以及处方/就诊比率。进行了描述性、双变量和多元线性回归分析。
预测药物支出增加的变量为：患者年龄、就诊次数、就诊频率、转诊至基层医疗专科医生、城市市镇、同时具有基层医疗和医院执业经历的医生、在职时间以及医生年龄。参与培训活动可预测药物节省，每参加一次基层医疗培训课程，每位使用者和每次就诊的药物支出平均每年分别节省50比塞塔和15比塞塔。每投入一小时社区培训，年度药物支出可节省近60,000比塞塔。对于每次合理用药课程，处方的平均价格降低52比塞塔。在得到的多元线性回归模型中，最常有助于解释开处方者之间药物支出差异的变量为：患者年龄、城市市镇以及基层医疗团队培训活动（作为药物节省的因素）。
本研究证实患者年龄、就诊频率和市镇类型会增加药物支出。与普遍看法相反，城市市镇与农村或半农村市镇相比，药物支出显著更高。我们的结果表明转诊至专科医生会使药物支出增加。一个有趣的新发现是同时具有基层医疗和医院执业经历的医生会产生更多药物支出。最后，我们强调培训基层医疗团队在促进药物节省（四种模式：每位使用者的药物支出、每次就诊的药物支出、每位使用者的处方数以及每次就诊的处方数）、合理用药活动（往往会降低处方的平均费用）以及社区培训活动（明显降低年度药物总支出）方面的重要性。
