Agency of Public Health, Lazio Region, Via S Costanza 53, 00198 Rome, Italy.
Health Policy. 2010 May;95(2-3):236-44. doi: 10.1016/j.healthpol.2009.12.005. Epub 2010 Jan 4.
Prescribing medications is one of the most important therapeutic activities of a general practitioner (GP) and the quality of such practices is a relevant issue. Our objective was to use regional administrative databases to assess the following: (a) the prevalence of prescription drug use by patient age and gender, (b) different GPs' prescription volumes and average drug expenditure, and (c) how GPs' socio-demographic variables may be considered as predictive factors in their prescribing practices.
An observational cross-sectional study was carried out in the primary care setting (GPs and paediatricians only) on drug utilization in the period 1st January-31st December 2007. Poisson regression models were run to estimate the incidence rate ratio (IRR) of prevalence adjusted by patients' age. Linear regression models (for GPs and paediatricians separately) were performed to test the possible association between average drug expenditure and physicians' characteristics.
The overall prevalence of drug utilization was approximately 65% of the total population and this finding is coherent with other studies. Age was a predictive determinant of average drug expenditure that was significantly higher for the elderly. Younger physicians were more likely to prescribe medications, independent of the presence of any chronic condition in their beneficiaries. Female GPs, those practicing in a group and those practicing in central Rome had a higher average drug expenditure. Results for paediatricians showed that there was a very strong geographical effect that influenced average expenditure.
Prescribing decisions are subject to a myriad of external factors. The present study shows how physicians' characteristics might affect drug prescription in terms of prevalence of use, costs and consumption. Using regional administrative databases it has been possible to analyse the association between doctors' prescribing habits, their socio-demographic factors and characteristics of their catchments areas. However, the variability in age groups in terms of prevalence, consumption and expenditure suggests that a sophisticated method of analysis will be needed in order to implement strategies and interventions able to optimise resource use in the health care sector.
开具处方是全科医生（GP）最重要的治疗活动之一，此类实践的质量是一个相关问题。我们的目的是使用区域行政数据库评估以下内容：（a）按患者年龄和性别划分的处方药使用的流行率，（b）不同 GP 的处方量和平均药物支出，以及（c）GP 的社会人口统计学变量如何可被视为其处方实践的预测因素。
在初级保健环境中（仅包括全科医生和儿科医生）进行了一项观察性横断面研究，研究时间为 2007 年 1 月 1 日至 12 月 31 日。使用泊松回归模型估计按患者年龄调整后的流行率的发病率比（IRR）。对平均药物支出与医生特征之间可能存在的关联进行了线性回归模型（分别针对全科医生和儿科医生）。
药物利用率的总体流行率约为总人口的 65%，这一发现与其他研究一致。年龄是平均药物支出的预测决定因素，对于老年人而言，这一支出显著更高。无论其受益人的慢性病状况如何，年轻医生更有可能开具药物。女性全科医生、在团体中执业的医生和在罗马市中心执业的医生的平均药物支出更高。儿科医生的结果表明，存在强烈的地域影响，这会影响平均支出。
处方决策受到众多外部因素的影响。本研究表明，医生的特征如何影响药物的使用频率、成本和消耗。使用区域行政数据库，可以分析医生的处方习惯与其社会人口统计学因素以及其就诊人群特征之间的关联。然而，不同年龄组在流行率、消耗和支出方面的差异表明，需要采用复杂的分析方法来实施能够优化医疗保健部门资源利用的策略和干预措施。
