喀拉拉邦糖尿病和高血压管理中的医疗处方质量及其相关因素。
Quality of medical prescriptions in diabetes and hypertension management in Kerala and its associated factors.
机构信息
Health Action by People, Thiruvananthapuram, Kerala, India.
Department of Community Medicine, Amrita Institute of Medical Sciences (AIMS), Kochi, Kerala, India.
出版信息
BMC Public Health. 2020 Feb 6;20(1):193. doi: 10.1186/s12889-020-8214-y.
BACKGROUND
Kerala is facing challenges in the secondary prevention efforts of non-communicable diseases (NCDs). In spite of being the top performer in health parameters among Indian states, the burden of NCDs, especially diabetes mellitus (diabetes) and hypertension, is higher in Kerala. This research endeavours to identify the role of quality of medical prescriptions in secondary prevention of diabetes and hypertension and suggest corrective measures.
METHODS
This cross-sectional study involved collection of prescription data and other details from consenting doctors across seven districts in Kerala. After the quality of prescription was assessed using a checklist, scores were generated, and cutoff points were used to classify the prescriptions. PASW version 18 software, was used for data analysis which included univariate and bivariate analyses and logistic regression. The proportion of quality prescriptions was estimated after adjusting for clustering, and the proportion of doctors writing quality prescriptions was also estimated. Prior to the study, ethical clearance from Independent ethics committee in Health action by People (HAP) and informed consent from all the study participants were obtained.
RESULTS
After assessing 9199 prescriptions from 344 doctors, it was found that about 37.2% (95% CI: 34.9-39.4%) of the prescriptions were of good quality, and 48.2% (95% CI: 42.9-53.7%) of the doctors provided quality prescriptions. Factors associated with quality prescriptions were found to be knowledge about NCD guidelines, quality certifications of hospitals and usage of patient data management software.
CONCLUSIONS
In the context of rising prevalence of NCDs and the challenges in the secondary prevention efforts, this is one of the first studies in Kerala to evaluate the quality of prescriptions to manage NCDs as prescriptions often reflect the quality of medical management. The study also addresses other factors associated with quality medical management. The findings indicate that the scope for improvement is more than 50%, when considered for the overall quality of prescriptions in diabetes and hypertension management. Further, it was found that appropriate training of doctors, adherence to treatment guidelines and the use of technology may improve the overall quality of prescriptions.
背景
喀拉拉邦在非传染性疾病（NCD）的二级预防工作中面临挑战。尽管在印度各邦的卫生参数方面表现最佳，但喀拉拉邦的 NCD 负担，尤其是糖尿病（糖尿病）和高血压，更高。这项研究旨在确定医疗处方质量在糖尿病和高血压二级预防中的作用，并提出纠正措施。
方法
这项横断面研究涉及从喀拉拉邦七个地区的同意医生那里收集处方数据和其他详细信息。使用检查表评估处方质量后，生成分数，并使用截止值对处方进行分类。PASW 版本 18 软件用于数据分析，包括单变量和双变量分析以及逻辑回归。在调整聚类影响后，估计了质量处方的比例，并且还估计了开具质量处方的医生的比例。在研究之前，从人民健康行动（HAP）的独立伦理委员会获得了伦理批准，并获得了所有研究参与者的知情同意。
结果
在评估了 344 名医生的 9199 张处方后，发现约 37.2%（95%CI：34.9-39.4%）的处方质量良好，48.2%（95%CI：42.9-53.7%）的医生提供了质量处方。与质量处方相关的因素被发现是对 NCD 指南的了解、医院的质量认证以及使用患者数据管理软件。
结论
在 NCD 患病率上升和二级预防工作面临挑战的背景下，这是喀拉拉邦评估管理 NCD 的处方质量的首批研究之一，因为处方通常反映了医疗管理的质量。该研究还解决了与高质量医疗管理相关的其他因素。研究结果表明，当考虑到糖尿病和高血压管理的整体处方质量时，改进的空间超过 50%。此外，发现适当的医生培训、遵守治疗指南和使用技术可能会提高整体处方质量。
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