Sibbald B, Addington-Hall J, Brenneman D, Freeling P
Division of General Practice and Primary Care, St George's Hospital Medical School, London.
Br J Gen Pract. 1996 Feb;46(403):63-7.
Counselling services are now widespread within general practice. Although the cost-effectiveness of such services has yet to be fully investigated, benefits could include a reduction in prescribing of psychotropic drugs and of other drugs.
A study set out to determine whether practices with counsellors differed from those without in terms of their prescribing rates and costs of psychotropic drugs.
Prescribing analyses and cost (PACT) level two data reports for the quarter to November 1991 ending January 1992, as appropriate, were sought from 354 practices with counsellors and a matched sample of 216 practices without counsellors which had participated in a previous national survey of counselling in general practice. The drug groups examined were: hypnotics and anxiolytics; antidepressants; analgesics; all central nervous system drugs; and all drugs apart from central nervous system drugs. For each group of drugs, the numbers of prescribed items, total prescribing costs, and costs per item were expressed as a proportion of the practice's number of prescribing units (that is, the age-adjusted number of registered patients) and as a percentage of the average for similar practices in its family health services authority. Practice characteristics were compared between practices with an on-site counsellor and those without. Practices with and without counsellors were compared with respect to their prescribing indicators.
PACT reports were obtained from 214 practices (response rate 38%)--126 with counsellors and 88 without. Practices with counsellors and practices without counsellors were well matched in terms of location, list size, proportion of elderly patients, training and fundholding status, and number of health promotion clinics. No significant differences were found between practices with and without counsellors in the prescribing indicators for any group of psychotropic drugs examined or for central nervous system drugs as a whole.
There were no appreciable differences found in this study between practices with and without counsellors in terms of psychotropic drug prescribing rates or costs. The reasons for this are unclear; more indepth studies of individual counselling services are required.
咨询服务如今在全科医疗中广泛存在。尽管此类服务的成本效益尚未得到充分研究，但其益处可能包括减少精神药物及其他药物的处方量。
一项研究旨在确定设有咨询师的医疗机构与未设咨询师的医疗机构在精神药物处方率及成本方面是否存在差异。
从354家设有咨询师的医疗机构以及216家与之匹配的未设咨询师的医疗机构（这些医疗机构参与了此前一次全国性的全科医疗咨询调查）获取了1991年第四季度至1992年1月（视情况而定）的处方分析与成本（PACT）二级数据报告。所考察的药物类别包括：催眠药和抗焦虑药；抗抑郁药；镇痛药；所有中枢神经系统药物；以及除中枢神经系统药物之外的所有药物。对于每类药物，处方项目数量、总处方成本及每项成本均表示为该医疗机构处方单位数量（即年龄调整后的注册患者数量）的比例，以及其家庭健康服务机构中类似医疗机构平均水平的百分比。对设有现场咨询师的医疗机构和未设咨询师的医疗机构的机构特征进行了比较。对设有和未设咨询师的医疗机构的处方指标进行了比较。
从214家医疗机构获取了PACT报告（回复率38%）——其中126家设有咨询师，88家未设咨询师。设有咨询师的医疗机构和未设咨询师的医疗机构在地理位置、名单规模、老年患者比例、培训及基金持有状况以及健康促进诊所数量方面匹配良好。在所考察的任何一类精神药物或整个中枢神经系统药物的处方指标方面，设有咨询师和未设咨询师的医疗机构之间均未发现显著差异。
在这项研究中，设有咨询师和未设咨询师的医疗机构在精神药物处方率或成本方面未发现明显差异。原因尚不清楚；需要对个体咨询服务进行更深入的研究。
