[First experiences in evaluating the clinical competence of family doctors in Catalonia]. / Primeras experiencias en evaluación de la competencia clínica de los médicos de familia de Catalunya.

OBJECTIVES: To construct a valid instrument to evaluate the clinical competence of family doctors and establish professional standards. DESIGN: Construction of an objective and structured clinical evaluation test by the Test Committee of the Catalan Society of Family and Community Medicine (SCMFiC) with 27 representative clinical situations of primary care practice. This used various evaluative instruments and lasted 5 hours and 30 minutes. SETTING: 2 Barcelona health districts for the two runnings of the test. PARTICIPANTS: Family doctors, SCMFiC members, who took part voluntarily after having been invited by letter. MEASUREMENTS AND MAIN RESULTS: 23 doctors took part in the first running of the test. Their average age was 36.6 (SD 6.9) and 52.2% of them were women. 46 doctors took part in the second test. Their average age was 30.9 (SD 2.1) and 76.1 were women. The test had an overall reliability coefficient (Cronbach's alpha) of 0.83 the first time and 0.65 the second time. The overall mean score of the participants the first time was 56.9 (SD 19.2), with 100 the top score possible, and 62.1 (SD 4.1) the second time. CONCLUSIONS: This SCMFiC experiment is the first time the clinical competence of family doctors has been assessed in our area. It was a reliable and valid test to assess the competence of our health professionals.

Primeras experiencias en evaluación de la competencia clínica de los médicos de familia de Catalunya / First experiences in evaluation of the clinical competence of family doctors in catalonia

Objetivo. Construir un instrumento válido para evaluar la competencia clínica de los médicos de familia y establecer el estándar de la profesión. Diseño. Construcción de una prueba de evaluación clínica objetiva y estructurada por parte del Comité de Prueba de la Societat Catalana de Medicina Familiar i Comunitària (SCMFiC) con 27 situaciones clínicas representativas de la práctica de atención primaria, utilizando diversos instrumentos evaluativos, con una duración total de 5 horas y 30 minutos. Emplazamiento. Dos áreas básicas de salud de Barcelona para la realización de las dos ediciones de la prueba. Participantes. Médicos de familia, miembros de la SCMFiC, que participaron voluntariamente tras haber sido invitados por carta. Mediciones y resultados principales. En la primera edición de la prueba participaron 23 médicos, con una edad media de 36,6 años (DE, 6,9), siendo un 52,2 por ciento mujeres. En la segunda edición participaron 46 médicos, con una edad media de 30,9 (DE, 2,1), siendo un 76,1 mujeres. La prueba tuvo un coeficiente global de fiabilidad, alfa de Cronbach, de 0,83 en su primera edición y 0,65 en su segunda. La puntuación media global de los participantes de la primera edición fue de 56,9 (DE, 19,2), siendo 100 la puntuación máxima obtenible y la de los participantes de la segunda edición, 62,1 (DE, 4,1). Conclusiones. La experiencia de la SCMFiC es la primera por lo que refiere a la evaluación de la competencia clínica de los médicos de familia en nuestro ámbito, y se trata de una prueba fiable y válida para valorar la competencia de nuestros profesionales (AU)

[Drug prescriptions in Catalonia following the Decree of Selective Financing of Drugs]. / La prescripción farmacéutica en Cataluña tras el Decreto de Financiación Selectiva de Medicamentos.

OBJECTIVES: To assess the consequences of the Selective Financial Decree for prescription drugs in Catalonia. METHODS: Observational longitudinal study of the registry of prescribed pharmaceutical specialties that were charged to the Catalan Service of Health, from august 1991 to July 1994. 243.8 million of prescriptions were analyzed. RESULTS: Between the 12 months prior to the Decree and the 12 months following, the number of drug prescriptions was reduced by 10%. As a whole, the drugs included in the decree were loosing sales before the Decree; 38% of then were not been prescribed at all during the period studied. The main groups affected by the Decree were, vitamins associations, stimulants an associations with cough suppressants, mainly with a low therapeutic value. There has only been and important and clear substitution effect in antianemic and cough suppressants associations. CONCLUSION: In general, substitutions between pharmaceutical groups were few and positive.

[Determining factors of the quality of prescription measured in intrinsic value and its potential use]. / Factores condicionantes de la calidad de la prescripción, medida en valor intrínseco y grado potencial de uso.

OBJECTIVE: To determine whether the following factors-medical training in family practice, age of the doctor, health care organization and percentage of patients over 65 years--influence the quality of pharmaceutical prescription as measured in terms of its intrinsic value and potential use of the prescription. DESIGN: Descriptive cross study. SITE. Regional health authorities of Costa de Ponent. Barcelona. PARTICIPANTS: 400 general practitioners throughout the whole of 1992. MAIN MEASUREMENTS AND RESULTS: Doctors belonging to the new health system and specialising in family practise, present higher intrinsic value and potential use of the prescription (statistically confirmed), as well as a greater concentration of prescription of the top 100 prescribed medicines. Doctors no more than 40 years old had better prescription but no statistical differences were found. An aged population had nearly no influence. CONCLUSIONS: The characteristics of the doctor (organization, training) are conditioning factors in the quality of pharmaceutical prescription.