Fraeyman J, De Winter J, De Loof H, Van Hal G, Beutels P, Remmen R, De Meyer G R Y
Universiteit Antwerpen, Medische Sociologie en Gezondheidsbeleid.
J Pharm Belg. 2013 Jun(2):18-31.
Since 2002 in Belgium, physicians are allowed to prescribe by International Non-proprietary Name (INN). In 2005, the conditions for this decree were set. Examples from other countries have shown that INN prescribing can significantly contribute to controlling pharmaceutical expenditures. The share of INN prescriptions remains low in Belgium (7% in 2011).
To formulate an answer to the question: what are the opinions and attitudes of pharmacists and general practitioners [GP's] with regards to INN prescribing?
In the winter of 2011-2012, a questionnaire with closed-ended questions was send to pharmacists and GP's in the provinces of Antwerp and East-Flanders, through training days and personal visits. Pharmacists and GP's scored a list of statements with a 5-point Likert scale. The themes of the statements related to: delivering INN prescriptions, legislation, impact on expenditures, choices regarding patient concerns and interprofessional relations.
In total, 353 questionnaires were completed and returned of which 228 165%1 were by pharmacists and 125 (35%1 by GP's. Although both declared to be sufficiently up to date with regulations to prescribe (84%) or to deliver (95%] a INN prescription, only 13% of the pharmacists said all prescription they receive contain the correct information. Less GP's [36%) than pharmacists (82%] feel aided by their software program when prescribing or delivering an INN prescription. GP's rely mostly on NIHDI (National Institute for Health and Disability Insurance) as the main source for information on INN prescribing, pharmacists rely on the [Local) pharmacists association. The pharmacists and GP's in the study who relied on NIHDI as main information source, were less aware of legislation concerning INN [N2, p<0,05] than those who rely on the local professional association [N2, p<0,0001]. All pharmacists in the study said to consider the patients medication history when delivering an INN prescription for chronic treatment. However, 57% of the GP's preferred not to prescribe by INN for the reason that they are not sure whether the pharmacist will always consider the patients medication history in case of an INN prescription. Although the GP's showed certain motivation to prescribe by INN, it was no greater than for generic prescribing. And INN prescribing has no added value compared to generic prescribing, according to the GP's. For the pharmacists, INN prescribing does contain an opportunity. With the increase in numbers of dosages and sorts of packaging of generic products, it becomes more and more difficult for pharmacists to manage their stock. In case of an INN prescription, the pharmacist can choose between the different packages in his stock. This offers opportunities especially for acute conditions.
INN prescribing is a good example of where the collaboration between pharmacists and GP's still contains a lot of opportunities, as well for the two professions, as the government and the patient in terms of controlling the pharmaceutical expenditures. Also the education for pharmacist or GP can further contribute to the sensitization of INN prescribing. In practice, there remain a number of issues and differences in opinions between pharmacists and general practitioners regarding INN prescribing. GP's feel few motivation to prescribe by INN and the government has put no imperative demands towards prescribers. Further evaluation of the practicaL feasibility of the current conditions for prescribing and delivering INN prescriptions is needed.
自2002年起在比利时，医生被允许使用国际非专利名称（INN）进行处方开具。2005年，该法令的条件得以确定。其他国家的例子表明，使用INN开具处方可显著有助于控制药品支出。在比利时，INN处方的占比仍然较低（2011年为7%）。
回答以下问题：药剂师和全科医生（GP）对于使用INN开具处方的意见和态度是什么？
在2011 - 2012年冬季，通过培训日和个人拜访，向安特卫普省和东佛兰德省的药剂师和全科医生发送了一份包含封闭式问题的问卷。药剂师和全科医生用5点李克特量表对一系列陈述进行评分。陈述的主题涉及：开具INN处方、立法、对支出的影响、关于患者关切的选择以及跨专业关系。
总共完成并收回了353份问卷，其中228份（65%）由药剂师填写，125份（35%）由全科医生填写。尽管两者都宣称对开具（84%）或调配（95%）INN处方的法规有足够了解，但只有13%的药剂师表示他们收到的所有处方都包含正确信息。在开具或调配INN处方时，感觉软件程序有帮助的全科医生（36%）比药剂师（82%）少。全科医生主要依赖国家健康与残疾保险研究所（NIHDI）作为INN处方信息的主要来源，药剂师则依赖（当地）药剂师协会。在该研究中，将NIHDI作为主要信息来源的药剂师和全科医生，比那些依赖当地专业协会的人对INN相关立法的了解更少（N2，p<0.05）（N2，p<0.0001）。该研究中的所有药剂师表示，在为慢性治疗开具INN处方时会考虑患者的用药史。然而，57%的全科医生出于不确定药剂师在开具INN处方时是否总会考虑患者用药史的原因，更倾向于不使用INN开具处方。尽管全科医生表现出一定的使用INN开具处方的积极性，但并不比开具通用名处方的积极性更高。并且根据全科医生的说法，与开具通用名处方相比，使用INN开具处方没有附加价值。对于药剂师而言，使用INN开具处方确实蕴含机会。随着通用产品剂型数量和包装种类的增加，药剂师管理库存变得越来越困难。在开具INN处方的情况下，药剂师可以在其库存中的不同包装之间进行选择。这尤其为急性病症提供了机会。
在控制药品支出方面，使用INN开具处方是一个很好的例子，说明药剂师和全科医生之间的合作对于这两个专业、政府和患者而言仍有很多机会。此外，对药剂师或全科医生的教育可以进一步促进对使用INN开具处方的认识。在实践中，药剂师和全科医生在使用INN开具处方方面仍存在一些问题和意见分歧。全科医生对使用INN开具处方的积极性不高，并且政府对开处方者没有强制要求。需要对当前开具和调配INN处方条件的实际可行性进行进一步评估。
