[Adoption of new medications by prescribing physicians. The innovator physician]. / Adopción de los nuevos medicamentos por los médicos prescriptores. El médico innovador.

OBJECTIVES: To determine how new medicines are adopted by primary care doctors, identifying innovators or first adopters. Also, to define the variables determining the characteristics of innovative doctors. DESIGN: Retrospective, longitudinal, observational and descriptive study. SETTING: Primary care doctors from the Bahía-Vejer Area in Cádiz (78 general practitioners and 22 paediatricians). MEASUREMENTS AND MAIN RESULTS: All the prescriptions dispensed in pharmacy offices between 1/1/94 and 31/12/96 and prescribed by doctors with over three years experience (74 doctors) were analysed. The active principles sold for the first time between 1/10/93 and 31/12/96 and mainly used in primary care were chosen. Medicines coming on prescription were grouped by three-month periods (28 medicines) and studied for a year. The number of containers of each group prescribed by each doctor was calculated. The doctors were classified in decreasing order according to the number of containers used and given scores through weighting more the initial periods of the prescription of each medicine. The characteristics of the innovative doctor were found with the following variables: age, gender, training, type of care network, type of contract, drugs expenditure and prescription quality through logistic regression. The OR of prevalence for each variable analysed was calculated, and 90% confidence intervals were also determined. 33% of the total (25 doctors) were identified as innovative doctors or first adopters. The statistically significant variables correlating with this group of doctors were: doctors aged > 45, male, non-MIR training, temporary contract, not their sole job, with drug expenditure over the area's 50 percentile, from non-reformed centres. CONCLUSIONS: The identification of this group of doctors will enable specific programmes to be set up in an attempt to alter their attitude to the marketing of new medicines (objective information, evaluation comparing new medicines with existing ones, and increasing doctors' awareness of perceived risk of the use of medicines).

Adopción de los nuevos medicamentos por los médicos prescriptores. El médico innovador / Adoption of new medicines by prescribing doctors. The innovative doctor

Objetivos. Determinar cómo son adoptados los nuevos medicamentos por los médicos de atención primaria, identificando a los innovadores o primeros adoptantes. Otro objetivo es definir las variables que determinan las características del médico innovador. Diseño. Estudio retrospectivo, longitudinal, observacional y descriptivo. Emplazamiento. Médicos de atención primaria del Distrito Bahía-Vejer de Cádiz (78 médicos generales y 22 pediatras). Mediciones y resultados principales. Se analizan todas las prescripciones realizadas por los médicos con más de 3 años de ejercicio (74 médicos) y dispensadas en oficinas de farmacia entre el 1-I-1994 y el 31-XII-1996. Se seleccionan los principios activos comercializados por primera vez desde el 1-X-1993 hasta el 31-XII-1996 y que sean de uso principal en atención primaria. Se agrupan los medicamentos que inician su prescripción por trimestres (28 medicamentos) y se estudian durante un año. Se calcula el número de envases de cada grupo prescrito por cada médico. Se ordenan los médicos en orden decreciente según el número de envases y se puntúan ponderando más los períodos iniciales de la prescripción de cada medicamento. Las características del médico innovador se obtienen con las siguientes variables: edad, sexo, formación, tipo de red asistencial, régimen de contratación, gasto farmacéutico y calidad de la prescripción mediante regresión logística. Se calcula la OR de prevalencia para cada variable analizada determinando también sus correspondientes intervalos de confianza del 90 por ciento. Se han identificado como médicos innovadores o primeros adoptantes al 33 por ciento del total (25 médicos). Las variables que se correlacionan con este grupo de médicos y que son estadísticamente significativas son: médicos con edad superior a 45 años, varones, con formación no MIR, no fijos, sin dedicación exclusiva, con desviación del gasto farmacéutico superior al percentil 50 del distrito, de centros no reconvertidos. Conclusiones. La identificación de este grupo de médicos permitirá establecer programas específicos para intentar modificar su actitud ante la comercialización de nuevos medicamentos (información objetiva, evaluación comparativa con los ya existentes y aumentar su nivel de riesgo percibido sobre el uso de los medicamentos) (AU)

[The quality of antibacterial prescription in a primary care district. Its evolution in 1994-1995]. / La calidad de la prescripción de antibacterianos en un distrito de atención primaria. Evolución 1994-1995.

OBJECTIVES: To analyse the profile and quality of antibacterials (ABs) prescription in a primary care (PC) district during 1994 and 1995. DESIGN: A longitudinal, descriptive and retrospective study. SETTING: PC doctors from the PC district Bahía de Cádiz (Cádiz). MEASUREMENTS AND MAIN RESULTS: The prescriptions for ABs belonging to the following groups were studied: JO1 (systemic antibiotics), JO3 (systemic chemotherapy drugs), GO4A (antiseptics and drugs for urinary infection) and RO5C1 (expectorants, with mucolytic drugs included with anti-infection ones). The unit of measurement was the daily defined dose (DDD). DDD per 1,000 inhabitants per day (DID) and the DDD percentage of each AB versus the total were used as quantitative indicators. The qualitative indicators were: origins of use of ABs in PC and %DDD of non-justified associations (NJA) (RO5C1 group). CONCLUSIONS: The prescription profile of ABs in the area is similar to, and somewhat more favorable than, that described in the literature for similar areas. In the reconverted network there was a more rational prescription than in the non-reconverted network for the two years of the study. In both types of network a light improvement in the indicators studied was observed from 1994 to 1995.