Tomson Y, Wessling A, Tomson G
Department of Clinical Neuroscience and Family Medicine, Karolinska Institutet, Huddinge, Sweden.
Eur J Clin Pharmacol. 1994;47(3):213-9. doi: 10.1007/BF02570500.
In the south west region of Stockholm a group of 125 general practitioners (GPs) at 27 health centres asked about the extent to which the drug formulary of the University Hospital was useful in their practices. To answer this question, the GPs asked their local pharmacies for prescribing data. When presented this started a process towards rational prescribing from within the group of GPs, including repeated prescribing surveys, starting with health centres as the unit of analysis and proceeding to individual prescribing analyses on request by the GPs. As the prescribing data revealed major differences between health centres, the GPs arranged two workshops on drug use in primary health care. They developed a list of 167 recommended drugs based on drug statistics and morbidity in general practice. Signs of increased cost cautiousness could be shown. There was a clear trend towards both smaller volumes and cost per prescription item for the health centres in the study area. Compared to the national prescribing pattern, prescribing practice in the study area represented a 20 per cent lower drug cost. Although the GPs decided on a drug list separate from that of the hospital, collaboration between the Drug and Therapeutic Committee at the hospital and the GPs increased as a result of their increased engagement in drug management, thereby also bridging the gap between primary health care and clinical pharmacology.
在斯德哥尔摩的西南部地区，27个健康中心的125名全科医生被问及大学医院的药品处方集在他们的诊疗实践中的有用程度。为了回答这个问题，全科医生向当地药房索要处方数据。当拿到这些数据后，全科医生群体内部开始了合理用药的进程，包括反复进行处方调查，最初以健康中心为分析单位，之后应全科医生的要求进行个体处方分析。由于处方数据显示各健康中心之间存在重大差异，全科医生组织了两次关于初级卫生保健中药物使用的研讨会。他们根据药物统计数据和全科医疗中的发病率制定了一份包含167种推荐药物的清单。可以看出成本谨慎性有所提高。研究区域内的健康中心在每张处方的用药量和成本方面都有明显的下降趋势。与全国处方模式相比，研究区域内的处方实践所产生的药品成本低20%。尽管全科医生制定了一份与医院不同的药品清单，但由于他们在药物管理方面的参与度提高，医院的药物与治疗委员会和全科医生之间的合作增加了，从而也缩小了初级卫生保健与临床药理学之间的差距。
