Bijl D, Van Sonderen E, Haaijer-Ruskamp F M
Northern Center for Health Care Research, University of Groningen, The Netherlands.
Eur J Clin Pharmacol. 1998 Jun;54(4):333-6. doi: 10.1007/s002280050469.
To explore the relevance of prescription changes and related drug costs when patients are referred from primary to secondary care.
Secondary analysis of data derived from a study on the quality of referrals, which was performed in 1989-1990. New and non-acute referrals of ambulatory patients were studied for internal medicine, neurology, and dermatology. Diagnoses were coded according to the ICPC, and drug names were coded according to the ATC. Prescription data were collected from referral letters and questionnaires. Drugs were also coded as generic or brand name products. Cost of treatment was calculated on the basis of information in the 1989 edition of the Dutch Public Health Care Drug Compendium taking into account the price of the drug and the duration of the prescription. Potential savings were calculated for those brand name products for which substitution by a similar drug was possible.
Data on 289 referrals, representing 289 patients, were available for analysis. In 126 out of the 289 patients (43.6%), specialists added to or changed prescriptions initiated by the general practitioner (GP). Specialist prescribing tended to shift to more chronic use. The costs of specialist prescribing are on average 23% higher than for GP prescriptions. Although specialists had fewer opportunities for generic substitution, the potential for savings was greater than for GPs. In many cases, the specialists changed the diagnosis. Only in neurology was the relative risk of receiving a prescription increased when the diagnosis changed.
Specialists have considerable influence on prescribing to outpatients. The number of prescriptions and the related costs increased greatly when patients were referred from primary to secondary care. The opportunities for generic substitution, and therefore for possible savings, are not fully exploited by GPs or specialists.
探讨患者从初级医疗转诊至二级医疗时处方变化及相关药物费用的相关性。
对1989 - 1990年进行的一项关于转诊质量研究的数据进行二次分析。研究了内科、神经科和皮肤科门诊患者的新转诊及非急性转诊情况。诊断按照国际初级保健分类法（ICPC）编码，药物名称按照解剖学治疗学及化学分类系统（ATC）编码。处方数据从转诊信和问卷中收集。药物也被编码为通用名或品牌名产品。治疗费用根据1989年版《荷兰公共医疗保健药物手册》中的信息计算，同时考虑药物价格和处方时长。对于那些有可能用类似药物替代的品牌名产品，计算了潜在节省费用。
有289例转诊患者的数据可供分析，代表289名患者。在289名患者中的126例（43.6%），专科医生增加或更改了全科医生（GP）开具的处方。专科医生的处方倾向于转向更多的长期用药。专科医生开处方的费用平均比全科医生的处方高23%。尽管专科医生进行通用名替代的机会较少，但潜在节省费用比全科医生更大。在许多情况下，专科医生更改了诊断。仅在神经科，诊断改变时接受处方的相对风险增加。
专科医生对门诊患者的处方开具具有相当大的影响。当患者从初级医疗转诊至二级医疗时，处方数量和相关费用大幅增加。全科医生和专科医生都没有充分利用通用名替代的机会，因此也就没有充分利用可能节省费用的机会。
