Gestión de la calidad en el Servicio de Salud de Castilla-La Mancha / Management of quality in the Castilla-La Mancha Health Care Service

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Variabilidad en la prescripción farmacéutica de atención primaria de castilla la mancha durante 2003 / Variability in primary care drug prescription in 2003 in Castile-la Mancha, Spain

Fundamento: Detectar la variabilidad en la práctica clínica esimportante, ya que puede implicar infra o sobreutilización de recursos.El objetivo del estudio fue estudiar en Castilla la Mancha lavariabilidad de la prescripción farmacéutica en Atención Primaria,en función de determinadas características sociosanitarias de cadazona de salud.Métodos: Se revisó en 180 zonas de salud la prescripción en2003 de varios grupos terapéuticos, recogiendo las siguientes variables:número de envases prescritos por 100 habitantes, porcentaje demayores de 65 años en la zona, frecuentación (consultas/1.000 habitantes),médicos/1.000 habitantes y distancia al hospital de referencia.Resultados: La mayor variabilidad en la prescripción se encontróen los fibratos (coeficiente de variación de 42,95%) y antiH2(38,61%). El grupo con mejor correlación entre su tasa de prescripcióny las variables analizadas fue el de los inhibidores de la enzimade conversión de la angiotensina (r de Spearman promedio 0,719);por contra, los antidepresivos tuvieron una correlación débil(0,324). El porcentaje de mayores de 65 años y la frecuentación sonlas variables que más aparecen de forma significativa en los modelosde regresión múltiple construidos para cada grupo terapéutico.El mayor coeficiente de determinación se encontró en el modelo delos inhibidores de la enzima de conversión de la angiotensina(R2=0,761). El coeficiente de determinación promedio de todos losgrupos, ponderado en base al volumen de prescripción, fue de0,492.Conclusiones: Se observa gran variabilidad en la prescripciónfarmacéutica según las distintas zonas. En general, las variables analizadasexplican en parte dicha variabilidad

Background: Detecting variability in clinical practice isimportant, given that it may entail the underuse or overuse ofresources. This study was aimed at studying the variability of drugprescription in Primary Care in Castile-La Mancha in terms of certainsociosanitary characteristics of each health district.Methods: The prescribing of various therapeutic groups in 2003was reviewed in 180 health districts, the following variables havingbeen gathered: number of packages having been prescribed per 100inhabitants, percentage of inhabitants over age 65 in the district, visitrate (visits/1,000 inhabitants), physicians/1,000 inhabitants and distanceto the reference hospital.Results: The greatest degree of drug-prescribing variability wasfound regarding fibrates (42.95% variance factor) and H2-blockers(38.61%). The group showing the closest correlation between itsprescription rate and the variables analyzed was that of the angiotensin-converting enzyme inhibitors (mean Spearman r: 0.719);antidepressants however showing a weak correlation (0.324).Thepercentage of inhabitants over age 65 and the visit rate are thevariables arising more significantly in the multiple regressionmodels constructed for each treatment group. The highest determinationcoefficient was found in the angiotensin enzyme-convertinginhibitors (R2=0.761). The mean determination coefficient for all ofthe groups, weighted on the basis of the prescribing volume, was0.492.Conclusions: A high degree of drug-prescribing variability wasfound to exist according to the different districts. Generally speaking,the variables analyzed explain part of this variability

[Variability in primary care drug prescription in 2003 in Castile-la Mancha, Spain]. / Variabilidad en la prescripción farmacéutica de atención primaria de Castilla la Mancha durante 2003.

BACKGROUND: Detecting variability in clinical practice is important, given that it may entail the underuse or overuse of resources. This study was aimed at studying the variability of drug prescription in Primary Care in Castile-La Mancha in terms of certain sociosanitary characteristics of each health district. METHODS: The prescribing of various therapeutic groups in 2003 was reviewed in 180 health districts, the following variables having been gathered: number of packages having been prescribed per 100 inhabitants, percentage of inhabitants over age 65 in the district, visit rate (visits/1,000 inhabitants), physicians/1,000 inhabitants and distance to the reference hospital. RESULTS: The greatest degree of drug-prescribing variability was found regarding fibrates (42.95% variance factor) and H2-blockers (38.61%). The group showing the closest correlation between its prescription rate and the variables analyzed was that of the angiotensin-converting enzyme inhibitors (mean Spearman p: 0.719); antidepressants however showing a weak correlation (0.324). The percentage of inhabitants over age 65 and the visit rate are the variables arising more significantly in the multiple regression models constructed for each treatment group. The highest determination coefficient was found in the angiotensin enzyme-converting inhibitors (R2=0.761). The mean determination coefficient for all of the groups, weighted on the basis of the prescribing volume, was 0.492. CONCLUSIONS: A high degree of drug-prescribing variability was found to exist according to the different districts. Generally speaking, the variables analyzed explain part of this variability.