Olmo M, Galvan L, Capdevila J, Serna C, Mangues I, Schoenenberger J A
Servicio de Farmacia, Hospital Universitari Arnau de Vilanova, Lleida, España.
Farm Hosp. 2011 Mar-Apr;35(2):58-63. doi: 10.1016/j.farma.2010.04.004. Epub 2010 Aug 3.
To verify that implementing a policy of management by objectives, based on collaboration between hospital pharmacy, primary care and specialised medical managers, improves prescription quality indicators in specialised care and reduces unwanted "induced" prescriptions (i.e. those issued by specialists, hospital doctors or the patients themselves) in primary care.
A four year quasi-experimental controlled intervention study on prescription at discharge and in outpatient hospital consultations was conducted. In hospital A, a quality cycle was applied: assessment, identifying improvement opportunities, implementing corrective actions and re-assessment. However, it was not applied in control hospital B. The indicators chosen were the percentage of generic medicines prescribed, the percentage of prescriptions for new therapies with no added value and the percentage of prescriptions for ACE inhibitors recommended.
In hospital A, an increase in indicators 1 and 3 has been observed, both being statistically significant, between the last year of intervention and the year previous to intervention. Hospital A managed to reduce indicator 2 to 4.5%, while this indicator increased in hospital B to 8.8%. Furthermore, a statistically significant difference in indicators between the two hospitals has been registered.
Pay-for-Performance programs in prescription practices of hospital physicians are effective actions to improve quality indicators of medication use.
验证基于医院药房、基层医疗和专科医疗管理人员之间合作实施目标管理政策，是否能改善专科护理中的处方质量指标，并减少基层医疗中不必要的“诱导性”处方（即由专科医生、医院医生或患者本人开具的处方）。
开展了一项为期四年的关于出院时及门诊医院会诊处方的准实验对照干预研究。在A医院，应用了一个质量循环：评估、识别改进机会、实施纠正措施和重新评估。然而，对照医院B未应用该质量循环。所选指标包括开具的通用药品百分比、无附加值新疗法的处方百分比以及推荐使用的ACE抑制剂处方百分比。
在A医院，观察到干预的最后一年与干预前一年相比，指标1和3有所增加，且均具有统计学意义。A医院成功将指标2降至4.5%，而该指标在B医院升至8.8%。此外，两家医院在指标方面存在统计学显著差异。
医院医生处方实践中的绩效薪酬计划是改善用药质量指标的有效举措。
