Buetow S A, Sibbald B, Cantrill J A, Halliwell S
National Primary Care Research and Development Centre, University of Manchester, UK.
Soc Sci Med. 1997 Jul;45(2):261-71. doi: 10.1016/s0277-9536(96)00342-5.
To help account for and address observed variations in medical practice, evaluations of "appropriateness" have sought to supplement incomplete evidence with professional opinion. This article contributes to an understanding and refinement of the construct of appropriateness by discussing how it has been defined and applied in studies of health care in general and prescribing in particular. We suggest that appropriateness is the outcome of a process of decision-making that maximises net individual health gains within society's available resources. This definition distinguishes between (in)appropriate prescribing, as an outcome, and (ir)rational prescribing as a process. To assess appropriateness, we advocate combining explicit criteria with independent review in cases of uncertainty and disagreement. Refinements based on reviews using implicit criteria should draw on shared professional knowledge and post hoc state the process followed as explicitly as possible. The Medication Appropriateness Index is shown to provide a solid foundation for identifying dimensions of prescribing appropriateness.
为了帮助解释和解决医疗实践中观察到的差异，对“适宜性”的评估试图用专业意见来补充不完整的证据。本文通过讨论适宜性在一般医疗保健研究，特别是在处方研究中是如何被定义和应用的，有助于理解和完善适宜性这一概念。我们认为，适宜性是一个决策过程的结果，即在社会可用资源范围内使个体健康净收益最大化。这个定义区分了作为结果的（不）适宜处方和作为过程的（不）合理处方。为了评估适宜性，我们主张在存在不确定性和分歧的情况下，将明确的标准与独立审查相结合。基于使用隐含标准的审查进行的改进应该借鉴共享的专业知识，并尽可能明确地事后说明所遵循的过程。药物适宜性指数被证明为识别处方适宜性维度提供了坚实的基础。
