Abstract
Objetivo
Evaluar la calidad de prescripción farmacéutica mediante la utilización de diferentes indicadores.
Diseño
Estudio retrospectivo transversal.
Emplazamiento
Prescripción extrahospitalaria en todas las provincias del INSALUD (excepto Ceuta y Melilla) durante un año (1997).
Mediciones
Se analizaron diferentes indicadores de calidad para los siguientes grupos de medicamentos: antidiabéticos orales, antiagregantes plaquetarios, antihipertensivos, antiinflamatorios no esteroides, tranquilizantes e hipnóticos, antibióticos, antiasmáticos e indicador de eficiencia del omeprazol. El consumo fue expresado en dosis diarias definidas (DDD) y en DDD por 1.000 personas y día (DHD). Se calculó un indicador de calidad de la prescripción (URM) a partir de una ponderación de los indicadores.
Resultados
Las sulfonilureas presentan gran variabilidad (15-56%) y gran desviación negativa respecto al valor estándar. AAS y ticlopidina suponen un 74% de los antiagregantes plaquetarios. El consumo de antagonistas del calcio es 3 veces mayor que el de bloqueadores beta. Captopril y enalapril constituyeron un 65% de los IECA. Ibuprofeno, naproxeno y diclofenaco suponen el 34-50% del total de AINE. La DHD de hipnóticos fue de 44 frente a un valor estándar de 24. El uso de antibióticos de primer nivel representa un 77%. Los adrenérgicos inhalados fueron un 80% respecto al total de antiasmáticos. El coste tratamiento día de omeprazol fue de 267 pts./DDD, siendo poco eficiente respecto al estándar de 190. Todas las provincias obtienen un valor de indicador URM superior a seis sobre diez.
Conclusiones
Los indicadores de IECA, antiasmáticos y antibióticos se apriximaron al estándar. La utilización de sulfonilureas, bloqueadores beta, AINE e hipnóticos se aleja mucho del valor estándar. El nivel de prescripción fue aceptable en las diferentes provincias.
Palabras clave: Consumo medicamentos, DDD, Indicadores calidad prescripción, Uso racional medicamentos
Abstract
Objective
To evaluate the quality of pharmaceutical prescription by means of various indicators.
Design
Cross-sectional, retrospective study.
Setting
Non-hospital prescription in all the INSALUD provinces, except Ceuta and Melilla, for a year (1997).
Measurements
Different quality indicators were analysed for the following groups of medicines: oral diabetes drugs, anti-platelet aggregation drugs, anti-hypertension drugs, non-steroidal antiinflammatories, tranquillisers and hypnotic drugs, antibiotics, anti-asthmatic drugs and the omeprazol efficiency indicator. Consumption was expressed in defined daily doses (DDD) and in DDD per 1000 persons and per day (DID). A prescription quality indicator was indicated on the basis of weighing up the indicators.
Results
The sulphonylurea drugs varied greatly (15-56%) and deviated negatively a lot from the standard value. AAS and ticlopidine made up 74% of the anti-platelet aggregation drugs. Consumption of calcium antagonists was three times greater than of beta-blockers. Captopril and enalapril were 65% of the ACE inhibitors. Ibuprofen, naproxen and diclofenac made up between 34 and 50% of the NSAIDs. The DID of hypnotics was 44 against a standard figure of 24. Use of first-level antibiotics was 77%. Inhaled adrenergic drugs came to 80% of total anti-asthmatic drugs. The cost of omeprazol treatment per day was 267 pesetas/DID, which was inefficient in comparison with the standard of 190. All provinces had a prescription quality indicator above six out of ten.
Conclusions
The ACE inhibitors, anti-asthmatic drugs and antibiotics were close to the standard. The use of sulphonylurea drugs, beta-blockers, NSAIDs and hypnotics was a long way from standard. The prescription level was acceptable in the different provinces.
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