Wathen Bernard, Dean Tara
North Devon District Hospital, Raleigh Park, Barnstaple, North Devon EX31 4JB, UK.
Br J Gen Pract. 2004 Feb;54(499):103-7.
One of the aims of the National Institute for Clinical Excellence (NICE) is to promote faster access to the best treatments. However, there is no published research on the impact that NICE guidance has had on prescribing decisions.
To explore the attitudes of general practitioners (GPs) to NICE guidance and to investigate any changes in prescribing patterns.
Descriptive cross-sectional study.
North Devon Primary Care Trust.
Five technology appraisals most likely to impact on GP prescribing were investigated. Prescribing analysis and cost (PACT) data were analysed for changes in prescribing patterns before and after the publication of each technology appraisal. A postal questionnaire, developed from semi-structured interviews, was sent to all GPs within a single primary care trust (PCT) to explore factors that were encouraging or discouraging adherence to NICE guidance.
PACT data showed that there was an increase in the prescribing of the drugs studied immediately after NICE guidance, with the exception of zanamivir (Relenza [GlaxoSmithKline]); only one zanamivir inhaler was prescribed during the study period. Although there was an increase in the prescribing of maintenance doses of proton pump inhibitors, there was also an increase in treatment doses. Eighty-one (82.7%) questionnaires were completed and returned. In general, there was a balance between the factors that encouraged and those that discouraged adherence. The main exception was zanamivir, where factors that discouraged adherence greatly exceeded factors that encouraged adherence.
This study showed that NICE guidance in isolation had little impact on GP prescribing. Where the guidance coincided with information from other sources, or personal experience, there was some evidence that technology appraisals triggered an increase in prescribing, but that this was not always sustained. The recommendations of NICE concerning zanamivir were universally rejected and there was evidence that this had undermined confidence in NICE recommendations in general.
英国国家临床优化研究所（NICE）的目标之一是促进更快地获得最佳治疗方法。然而，尚无关于NICE指南对处方决策影响的已发表研究。
探讨全科医生（GP）对NICE指南的态度，并调查处方模式的任何变化。
描述性横断面研究。
北德文郡初级保健信托基金。
调查了最有可能影响全科医生处方的五项技术评估。分析了处方分析与成本（PACT）数据，以了解每项技术评估发布前后处方模式的变化。根据半结构化访谈制定的邮政问卷被发送给单个初级保健信托基金（PCT）内的所有全科医生，以探讨鼓励或阻碍遵循NICE指南的因素。
PACT数据显示，在NICE指南发布后，除扎那米韦（瑞乐沙[葛兰素史克公司]）外，所研究药物的处方量立即增加；在研究期间仅开出了一支扎那米韦吸入器。虽然质子泵抑制剂维持剂量的处方量有所增加，但治疗剂量也有所增加。81份（82.7%）问卷已完成并返回。总体而言，鼓励和阻碍遵循指南的因素之间保持平衡。主要例外是扎那米韦，阻碍遵循指南的因素大大超过鼓励遵循指南的因素。
本研究表明，单独的NICE指南对全科医生的处方影响不大。当指南与其他来源的信息或个人经验一致时，有证据表明技术评估会引发处方量增加，但这种情况并不总是持续的。NICE关于扎那米韦的建议被普遍拒绝，并且有证据表明这总体上削弱了对NICE建议的信心。
