Horn Fiona E, Mandryk John A, Mackson Judith M, Wutzke Sonia E, Weekes Lynn M, Hyndman Rob J
National Prescribing Service Ltd, Surry Hills, Sydney, NSW 2012, Australia.
Pharmacoepidemiol Drug Saf. 2007 Mar;16(3):297-308. doi: 10.1002/pds.1243.
To measure changes in drug utilisation following a national general practice education program aimed at improving prescribing for hypertension.
A series of nationally implemented, multifaceted educational interventions using social marketing principles focusing on prescribing for hypertension, was commenced in October 1999, and repeated in September 2001 and August 2003. The target group was all primary care prescribers in Australia and interventions were both active (voluntary) and passive. Newsletter and prescribing feedback was mailed in October 1999, September 2001 (newsletter only) and August 2003. Approximately a third of general practitioners (GPs) in Australia undertook at least one active educational activity (clinical audit, educational visit or case study) during the period October 1999-April 2004. National dispensing data from 1996 to 2004 were analysed using time series methodology with a decay term for intervention effect, to assess trends in prescribing of various classes of antihypertensives. In particular, the program aimed to increase the prescribing of thiazide diuretics and beta blockers.
Consistent with key intervention messages, the program achieved an increase in low-dose thiazide and beta blocker prescribing. The rate of prescribing of low-dose thiazides doubled from 1.1 per 1000 consultations in October 1999 to 2.4 per 1000 in October 2003. Beta-blocker utilisation showed a more modest but significant increase over the time of the study, with the change in observed versus expected rate of prescribing increasing by 8% by April 2004. Therapeutic options for treating hypertension changed markedly in the time of the study with the advent of ACE inhibitor/Angiotensin II receptor antagonists and thiazide combination products. It is important, therefore, to interpret the results in light of these changes.
A national education program aimed at GPs was successful in improving prescribing for hypertension. Lessons learned will be applied in evaluation of future NPS programs and are also applicable to analysis of other interventions aimed at influencing prescribing behaviour.
评估一项旨在改善高血压用药处方的全国性全科医学教育项目实施后药物使用情况的变化。
1999年10月启动了一系列全国性实施的、多方面的教育干预措施，运用社会营销原则聚焦高血压用药处方，并于2001年9月和2003年8月重复实施。目标群体为澳大利亚所有初级保健处方医生，干预措施包括主动（自愿）和被动两种。1999年10月、2001年9月（仅时事通讯）和2003年8月邮寄了时事通讯和处方反馈。在1999年10月至2004年4月期间，澳大利亚约三分之一的全科医生（GP）至少参加了一项主动教育活动（临床审计、教育访问或案例研究）。使用带有干预效果衰减项的时间序列方法分析了1996年至2004年的全国配药数据，以评估各类抗高血压药物的处方趋势。特别是，该项目旨在增加噻嗪类利尿剂和β受体阻滞剂的处方量。
与关键干预信息一致，该项目实现了低剂量噻嗪类药物和β受体阻滞剂处方量的增加。低剂量噻嗪类药物的处方率从1999年10月每1000次会诊1.1例翻倍至2003年10月每1000次会诊2.4例。在研究期间，β受体阻滞剂的使用量有较为适度但显著的增加，到2004年4月，观察到的与预期的处方率变化增加了8%。随着血管紧张素转换酶抑制剂/血管紧张素II受体拮抗剂和噻嗪类联合产品的出现，研究期间治疗高血压的治疗选择发生了显著变化。因此，根据这些变化来解释结果很重要。
一项针对全科医生的全国性教育项目成功改善了高血压用药处方。吸取的经验教训将应用于未来国家药品与卫生服务质量标准项目的评估，也适用于分析其他旨在影响处方行为的干预措施。
