Juncosa S, Ledesma A, Carvajal J A
Area Básica de Salut de Santa Eugènia de Berga, Barcelona.
Med Clin (Barc). 1994 Sep 10;103(7):252-7.
The evaluation and quality control of antibiotic prescription has become widespread in primary health care (PHC). Most of the studies performed have analyzed the quality of the drug and not the treatment. The aim of this study was to evaluate the quality of the antibiotic treatments of physicians in a concrete area and identify the most deficient aspects.
A prospective study was performed with the voluntary participation of general physicians and pediatricians of the PHC area of Osona (Barcelona, Spain) by the collection of a series of data of each antibiotic treatment carried out over 30 days. Consideration of each item to evaluate the quality of a given treatment was carried out by a nominal group.
A total of 1,976 antibiotic treatments were administered by the 44 physicians participating in the study (68% of the target population). The aspect found to be most deficient was that 20% of the doctors prescribed an antibiotic in a diagnosis for which it was not susceptible and in 30% of the susceptible cases the choice of antibiotic was erroneous. The length of treatment was the aspect on posology showing the worst results (27% incorrect). The mean quality following the application of the scale elaborated by the nominal group was 72.6 (SD = 25.7) over a maximum of 100. Lower quality was observed in the pediatricians (p = 0.006), in the physicians working in the reformed network (p < 0.0001), in the prescriptions induced by another physician (p = 0.0001) and in those induced by the patient (p = 0.03).
The number of antibiotics prescribed in non susceptible processes in primary health care should be reduced. Likewise, the choice of antibiotics prescribed should improve.
抗生素处方的评估与质量控制在初级卫生保健（PHC）中已广泛开展。大多数已开展的研究分析了药物质量而非治疗质量。本研究的目的是评估某一具体地区医生的抗生素治疗质量，并找出最欠缺的方面。
在西班牙巴塞罗那奥索纳初级卫生保健区的全科医生和儿科医生自愿参与下进行了一项前瞻性研究，收集了30天内开展的每项抗生素治疗的一系列数据。由一个名义小组对评估给定治疗质量的每个项目进行考量。
参与研究的44名医生共开出了1976份抗生素处方（占目标人群的68%）。发现最欠缺的方面是，20%的医生在一种抗生素不敏感的诊断中开具了该抗生素，在30%的敏感病例中抗生素选择错误。治疗时长是剂量学方面结果最差的（27%不正确）。应用名义小组制定的量表后，平均质量为72.6（标准差=25.7），满分100分。儿科医生（p = 0.006）、在改革网络中工作的医生（p < 0.0001）、由另一名医生诱导开具的处方（p = 0.0001）以及由患者诱导开具的处方（p = 0.03）的质量较低。
应减少初级卫生保健中在不敏感病程中开具的抗生素数量。同样，所开抗生素的选择也应改善。
