Lexchin J
Int J Health Serv. 1998;28(2):253-67. doi: 10.2190/ABWY-YFPA-ME5R-7BQP.
Appropriate prescribing means that prescribers should try to maximize effectiveness, minimize risks and costs, and respect patients' choices. Evidence from studies on prescribing to individuals and from administrative databases reveals a significant level of inappropriate prescribing by Canadian physicians. Two important reasons for inappropriate prescribing seem to be physicians' level of knowledge and physicians' practice settings. A large number of methods have been tried to improve prescribing behavior, but most are unsuccessful. Academic detailing, and audit and feedback, have both been shown to work but may be difficult to implement in Canada, where most physicians practice in solo fee-for-service settings. Alternative forms of physician payment such as capitation or salary are probably necessary to make prescribing more appropriate.
合理开药意味着开处方者应努力使疗效最大化，将风险和成本降至最低，并尊重患者的选择。针对个体开药的研究以及行政数据库提供的证据表明，加拿大医生存在相当程度的不合理开药现象。不合理开药的两个重要原因似乎是医生的知识水平和医生的执业环境。人们尝试了大量方法来改善开药行为，但大多数都未成功。学术指导以及审核与反馈都已证明有效果，但在加拿大可能难以实施，因为在加拿大，大多数医生以按服务收费的独立执业方式行医。可能需要采用诸如按人头付费或薪金等替代形式的医生薪酬方式，以使开药更合理。
