Segura-Benito M J, Moya-Martínez P, Escribano-Sotos F
Atención Primaria, Servicio de Salud de Castilla-La Mancha, Cuenca, España.
Rev Calid Asist. 2012 Nov-Dec;27(6):345-50. doi: 10.1016/j.cali.2012.02.011. Epub 2012 Apr 30.
Aging and medicalisation are leading to a progressive growth in pharmaceutical expenditure, which is difficult to measure. It is important to develop social studies of this drug spending in order to support the policies of containment. The aim of this study is to identify elements that influence pharmaceutical expenditure of Primary Care physicians in the Health Area of Cuenca (Spain).
A retrospective observational study using multilevel models of pharmaceutical expenditures by physicians between 2006 and 2009. It took into account the particular characteristics of each doctor and their patients.
The average pharmaceutical expenditure by doctor and patient was € 277.13 year. In addition, a one-point of increase in the rate of referrals to specialised care increases pharmaceutical expenditure by 2.97 € per year and an increase in the percentage of generic drugs prescribed reduced in 2.54 € per year. These two variables and the percentage of retired patients (pensioners) are the most important factors to explain the variability in pharmaceutical expenditure. In contrast, the characteristics of physicians such as education, tenure, seniority, or age does not influence pharmaceutical costs.
This study supports the importance of developing interventions in prescription policies. It will be of particular interest to those physicians with higher quotas of elderly patients. It also shows a significant relationship in pharmaceutical expenditures between primary and specialist physicians, which needs to be clarified by future studies.
老龄化和医疗化导致药品支出不断增加，而这一支出难以衡量。开展关于这种药品支出的社会研究对于支持控制政策至关重要。本研究的目的是确定影响昆卡（西班牙）卫生区基层医疗医生药品支出的因素。
采用回顾性观察研究，运用2006年至2009年医生药品支出的多层次模型。研究考虑了每位医生及其患者的特殊特征。
每位医生和患者的平均药品支出为每年277.13欧元。此外，转诊至专科护理的比率每增加1个百分点，药品支出每年增加2.97欧元，而处方中通用药物百分比的增加使每年减少2.54欧元。这两个变量以及退休患者（领取养老金者）的百分比是解释药品支出变化的最重要因素。相比之下，医生的教育程度、任期、资历或年龄等特征不会影响药品成本。
本研究支持在处方政策方面开展干预措施的重要性。这对于老年患者配额较高的医生来说将特别有意义。研究还显示了基层医生和专科医生在药品支出方面存在显著关系，这需要未来的研究加以阐明。
