De Bruyne Florent, Ponçon Arnaud, Giai Joris, Dode Xavier, Darmon David, Colin Cyrille, Gueyffier François, Letrilliart Laurent
Collège universitaire de médecine générale, Univ. Lyon, Université Claude Bernard Lyon 1, Université Saint-Etienne, F-42023, Saint-Etienne, France.
Université Lyon 1, F-69622, Villeurbanne, France.
Eur J Clin Pharmacol. 2019 Feb;75(2):275-283. doi: 10.1007/s00228-018-2580-8. Epub 2018 Oct 27.
The prescription in International Nonproprietary Names (INN) is a legal obligation for all physicians in France since January 2015. The objective of this study was to analyze the frequency and main factors of INN drug prescribing in general practice.
Multicenter cross-sectional study conducted with 11 interns acting as observers of 23 GP trainers between November 2015 and January 2016. Two evaluators analyzed all GPs' drug prescriptions to identify INN or brand name prescriptions.
The database included 4957 drugs prescribed during 1647 visits. Of these, 1462 (29.5% [95% CI 28.2-30.8%]) were prescribed only in INN. According to the multivariate analyses, the factors favoring INN prescribing were as follows: at the drug level, its initial prescribing (OR = 1.4), a nonspecific prescribing objective (OR = 1.6), its listing in the generic drug index with (OR = 7.7) or without (OR = 2.9) efficiency objective included in the payment for public health objectives (PPHO) program, and the oral route of administration (OR from 0.4 for the percutaneous route to 0.2 for the pulmonary route); at the patient level, the male gender (OR = 1.3), the age of 15 years or more (OR = 1.9), and the absence of a long-term condition (OR = 1.3); at the physician level, the reception of a public healthcare insurance representative (OR = 4.1), the nonreception of pharmaceutical sales representatives (OR = 3.0), and the urban practice environment (OR = 2.8).
In 2015, less than one third of drugs were prescribed in INN only in general practice. The use of various incentives and regulatory measures is likely to favor the prescription of INNs by practitioners.
自2015年1月起，使用国际非专利名称（INN）开具处方对法国所有医生来说都是一项法律义务。本研究的目的是分析全科医疗中使用INN药物开具处方的频率及主要因素。
2015年11月至2016年1月期间，对11名实习医生作为观察员观察23名全科医生培训师进行了多中心横断面研究。两名评估人员分析了所有全科医生的药物处方，以确定是使用INN还是品牌名称开具的处方。
该数据库包括在1647次就诊期间开具的4957种药物。其中，1462种（29.5%[95%CI 28.2 - 30.8%]）仅以INN形式开具。根据多变量分析，有利于使用INN开具处方的因素如下：在药物层面，其初次开具处方（OR = 1.4）、非特定的开具处方目的（OR = 1.6）、其列入通用药物索引且在公共卫生目标付费（PPHO）计划中包含（OR = 7.7）或不包含（OR = 2.9）有效性目标，以及口服给药途径（经皮途径的OR为0.4，肺部途径的OR为0.2）；在患者层面，男性（OR = 1.3）、15岁及以上年龄（OR = 1.9）以及无长期疾病（OR = 1.3）；在医生层面，接待公共医疗保险代表（OR = 4.1）、不接待药品销售代表（OR = 3.0）以及城市执业环境（OR = 2.8）。
2015年，在全科医疗中仅以INN形式开具处方用药的比例不到三分之一。使用各种激励措施和监管措施可能会促使从业者使用INN开具处方。
