López-Sepúlveda Rocío, García Lirola María Ángeles, Espínola García Esther, Martín Sances Salvadora, Anaya Ordóñez Sonia, Jurado Martínez José María, Cabeza Barrera José
Unidad Gestión Clínica de Farmacia Provincial de Granada, Distrito Sanitario Granada Metropolitano, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada, Granada, Spain.
Unidad de Gestión Clínica de Farmacia Provincial de Granada, Complejo Hospitalario de Granada, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada., Granada, Spain.
Eur J Clin Pharmacol. 2017 Apr;73(4):455-461. doi: 10.1007/s00228-016-2180-4. Epub 2016 Dec 27.
The objective of this study was to measure the impact of an intervention on the prescription habits of general practitioners (GPs) in order to improve the quality of zolpidem prescriptions in patients aged 75 or older.
A prospective multicentric non-randomized trial was performed in the Metropolitan Granada Primary Healthcare Area (Andalusian Public Healthcare Service, Spain), which serves a total population of approximately 675,000 inhabitants. All health centers volunteering to participate in the trial were included. The intervention consisted of training sessions, individualized feedback, clinical information, and financial incentives. A daily dose over 5 mg was considered non-safe. Reduction in non-safe prescriptions of zolpidem in the elderly population became a quality prescribing indicator in a pay-for-performance scheme.
Statistically significant differences versus baseline were found between the intervention and control groups in mean zolpidem prescription prevalence (28.5 vs. 37.5‰, respectively; p = 0.008) and mean non-safe zolpidem prescription prevalence (16.5 vs. 34.2‰, respectively; p < 0.001). At the end of the study period, the total number of non-safe prescriptions was 1309, 35% lower versus baseline, with a significant difference of p < 0.001; the number in the intervention (510 vs. 1118; p < 0.001) and control (799 vs. 893; p = 0.0064) groups was also significantly lower, with a significantly greater percentage reduction in the intervention group (54.4 vs. 10.5%, p < 0.001).
The quality prescribing indicator in our area was improved by the intervention developed. Further studies that include an intervention group of GPs who receive no financial incentive are required to evaluate the relative importance of an economic reward in achieving this improvement.
本研究的目的是评估一项干预措施对全科医生（GP）处方习惯的影响，以提高75岁及以上患者唑吡坦的处方质量。
在格拉纳达大都会初级卫生保健区（西班牙安达卢西亚公共卫生服务机构）进行了一项前瞻性多中心非随机试验，该地区总人口约为67.5万居民。所有自愿参与试验的健康中心均被纳入。干预措施包括培训课程、个性化反馈、临床信息和经济激励。每日剂量超过5毫克被视为不安全。在按绩效付费计划中，老年人群中唑吡坦不安全处方的减少成为质量处方指标。
干预组和对照组在唑吡坦平均处方流行率（分别为28.5‰和37.5‰；p = 0.008）和唑吡坦平均不安全处方流行率（分别为16.5‰和34.2‰；p < 0.001）方面与基线相比存在统计学显著差异。在研究期结束时，不安全处方总数为1309例，比基线降低了35%，p < 0.001，差异显著；干预组（510例对1118例；p < 0.001）和对照组（799例对893例；p = 0.0064）的数量也显著降低，干预组降低的百分比显著更高（54.4%对10.5%，p < 0.001）。
所开展的干预措施改善了我们地区的质量处方指标。需要进一步开展研究，纳入未接受经济激励的全科医生干预组来评估经济奖励在实现这一改善中的相对重要性。
