Carlzon Daniel, Gustafsson Lena, Eriksson Anna L, Rignér Karin, Sundström Anders, Wallerstedt Susanna M
Department of Clinical Pharmacology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.
BMC Clin Pharmacol. 2010 Feb 15;10:4. doi: 10.1186/1472-6904-10-4.
Adherence to prescribing guidelines varies between primary health care units. The aim of the present study was to investigate correlations between characteristics of primary health care units and adherence to prescribing objectives for rational drug use with focus on drug information from the pharmaceutical industry.
A cross-sectional study was performed in all 25 primary health care units in Göteborg, Sweden. A questionnaire on characteristics of practice settings [(i) size of unit, (ii) profession of head, (iii) use of temporary physicians, (iv) drug information from the pharmaceutical industry, (v) producer-independent drug information, and (vi) education on prescribing for newly employed physicians] was sent to the heads of the units. A national sales register for prescribed drugs (Xplain) was used for evaluation of adherence to the six regional prescribing objectives concerning proton pump inhibitors (PPIs), angiotensin converting enzyme inhibitors (ACEIs), statins and antidepressants.
Twenty-two out of 25 primary health care units responded to the questionnaire (response rate 88%). A physician as head and presence of producer-independent drug information was positively correlated with adherence to the prescribing objectives (median number of prescribing objectives adhered to (25th - 75th percentile): 2.5 (1-3.25) vs 1 (0-2), P = 0.013; 2 (1-3) vs 0, P = 0.043, respectively. Presence of drug information from the pharmaceutical industry and education on prescribing for newly employed physicians was negatively associated with adherence to the prescribing objectives: 1 (0-2) vs 3.5 (2.25-4.75), P = 0.005; 1 (0-2) vs 3 (1.5-4), P = 0.034, respectively.
Several characteristics of the primary health care units correlated with adherence to prescribing objectives for rational drug use. Further research on this topic is needed and would constitute valuable information for health care decision makers.
初级卫生保健单位在遵循处方指南方面存在差异。本研究的目的是调查初级卫生保健单位的特征与遵循合理用药处方目标之间的相关性，重点关注来自制药行业的药物信息。
在瑞典哥德堡的所有25个初级卫生保健单位进行了一项横断面研究。向各单位负责人发送了一份关于实践环境特征的问卷[（i）单位规模，（ii）负责人职业，（iii）临时医生的使用，（iv）来自制药行业的药物信息，（v）独立于生产商的药物信息，以及（vi）对新聘用医生的处方教育]。使用国家处方药销售登记册（Xplain）评估对关于质子泵抑制剂（PPI）、血管紧张素转换酶抑制剂（ACEI）、他汀类药物和抗抑郁药的六项区域处方目标的遵循情况。
25个初级卫生保健单位中有22个回复了问卷（回复率88%）。负责人为医生以及存在独立于生产商的药物信息与遵循处方目标呈正相关（遵循的处方目标中位数（第25 - 75百分位数）：2.5（1 - 3.25）对1（0 - 2），P = 0.013；2（1 - 3）对0，P = 0.043）。来自制药行业的药物信息以及对新聘用医生的处方教育与遵循处方目标呈负相关：1（0 - 2）对3.5（2.25 - 4.75），P = 0.005；1（0 - 2）对3（1.5 - 4），P = 0.034）。
初级卫生保健单位的几个特征与遵循合理用药处方目标相关。需要对该主题进行进一步研究，这将为医疗保健决策者提供有价值的信息。
