Department of Health Psychology, Universidad Miguel Hernández de Elche, Elche, Spain.
Salud Alicante-Sant Joan Health District, Alicante, Spain.
BMJ Open. 2019 Mar 4;9(3):e023399. doi: 10.1136/bmjopen-2018-023399.
Several institutions and quality national agencies have fostered the creation of recommendations on what not to do to reduce overuse in clinical practice. In primary care, their impact has hardly been studied. The frequency of adverse events (AEs) associated with doing what must not be done has not been analysed, either. The aim of this study is to measure the frequency of overuse and AEs associated with doing what must not be done (commission errors) in primary care and their cost.
A coordinated, multicentric, national project. A retrospective cohort study using computerised databases of primary care medical records from national agencies and regional health services will be conducted to analyse the frequency of the overuse due to ignore the do-not-do recommendations, and immediately afterwards, depending on their frequency, a representative random sample of medical records will be reviewed with algorithms (triggers) that determine the frequency of AEs associated with these recommendations. Cost will determine by summation of the direct costs due to the consultation, pharmacy, laboratory and imaging activities according to the cases.
The study protocol has been approved by the Ethics Committee of Primary Care Research of the Valencian Community. We aim to disseminate the findings through international peer-reviewed journals and on the website (http://www.nohacer.es/). Outcomes will be used to incorporate algorithms into the electronic history to assist in making clinical decisions.
NCT03482232; Pre-results.
一些机构和国家级质量保证机构已经提出了一些建议，旨在减少临床实践中的过度医疗行为。但这些建议在基层医疗中的影响尚未得到充分研究，而且也没有分析过与做不该做的事情（即执行禁止性医嘱）相关的不良事件（AE）的发生频率和所带来的成本。本研究旨在测量基层医疗中因忽视禁止性医嘱而导致的过度医疗行为的发生频率和相关不良事件及其成本。
这是一项协调的、多中心的、全国性的项目。将采用回顾性队列研究，利用国家机构和区域卫生服务的基层医疗计算机数据库，分析因忽视禁止性医嘱而导致的过度医疗行为的发生频率，然后根据其发生频率，对医嘱进行代表性的随机抽样，并使用确定与这些医嘱相关的 AE 发生频率的算法（触发因素）进行审核。成本将根据案例确定，通过汇总因咨询、药房、实验室和影像学活动而产生的直接成本来确定。
该研究方案已经得到了瓦伦西亚社区初级保健研究伦理委员会的批准。我们的目标是通过国际同行评议期刊和网站（http://www.nohacer.es/）来传播研究结果。研究结果将用于将算法纳入电子病历，以协助临床决策。
NCT03482232；预注册结果。
