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首页> 外文期刊>International journal of clinical pharmacology and therapeutics >Development of indicators for assessing the quality of prescribing of lipid-lowering drugs: data from the pharmacotherapeutic quality circles in Hesse, Germany.
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Development of indicators for assessing the quality of prescribing of lipid-lowering drugs: data from the pharmacotherapeutic quality circles in Hesse, Germany.

机译：制定评估降脂药处方质量的指标：德国黑森州药物治疗质量界的数据。

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OBJECTIVE: To develop indicators based on prescription analysis in order to assess adherence using guidelines and to monitor prescribing behavior. SETTING AND MATERIAL: Eleven pharmacotherapeutic circles (PTC) of the Association of Statutory Health Insurance Physicians (KV Hesse; 10 PTCs including 155 GPs as participants, mostly high prescribers; one circle with 11 moderators trained in pharmacology). These provided a total of 183,997 drug prescriptions involving 54,970 patients (prescriptions reimbursed by the substitute fund--Ersatzkassen--II. quarter 2000); claims form from 151 GPs. On average, 5.1% of the patients with prescriptions received lipid-lowering drugs. METHOD: Development and application of indicators based on the guideline for the treatment of hypercholesterolemia developed by a GP's guideline group of the quality circles in Hesse (Hausarztliche Leitliniengruppe Hessen). The ratio of prescribing for primary and secondary prevention was chosen as a top indicator for measuring adherence to the guideline. Prescribing for secondary prevention was assessed by a set of special diagnoses. The second indicator relates to patient groups (here: older than 75 years) where the benefit of prescribing is not clear. Further indicators measure the prescribing of first choice drugs, avoidance of risk combinations and costconscious prescribing. The indicators are presented in the prescription analysis and will be discussed during the circle meeting. RESULTS: On average, the moderators prescribed 34% of the lipid-lowering drugs for primary prevention, the GP circle participants 36.7%. On average, moderators and GP participants prescribed lipid-lowering drugs for 4.9% and 7.5% of patients older than 75 years, respectively (6% and 22% in primary prevention). Approximately, 28% of all lipid-lowering drugs issued by the participants involved simvastatin and pravastatin as first-choice drugs compared to 36.5% in the case of the moderators. The prescribing of statins with fibrates or macrolides in combination is seldom. Cost-conscious prescribing can be assessed for each GP by the percentage of generic prescribing and the number of different brands per active agent. Both, moderators and participants used generics when prescribing fibrates, bile acid sequestrants or other types of lipid-lowering drugs (moderators 53.8% and GP participants 78.5%). Three months is too short a period for assessing compliance of lipid-lowering drug prescribing. CONCLUSION: It is possible to derive indicators from the guidelines and to integrate them into prescription analysis. The indicators reveal prescribing problems. The evaluation of PTCs in 2002 will involve the use of indicators as an instrument to assess the success in the implementation of guidelines.
机译：目的：开发基于处方分析的指标，以使用指南评估依从性并监测处方行为。地点和材料：法定健康保险医师协会的11个药物治疗圈子（PTC）（KV Hesse; 10个PTC，包括155名GP参加者，多数为高级处方;一个圈子，其中11位主持人接受了药理学培训）。这些共提供了183,997张药物处方，涉及54,970名患者（处方药-Ersatzkassen-II。2000年第四季度报销）; 151名GP的索赔表。平均而言，有处方的患者中有5.1％接受过降脂药。方法：根据由黑森州质量圈子的GP指南小组制定的高胆固醇血症治疗指南制定和应用指标（Hausarztliche Leitliniengruppe Hessen）。选择一级预防和二级预防的处方比例作为衡量对指南遵守情况的最高指标。通过一系列特殊诊断评估了二级预防的处方。第二项指标与患者的处方（处方年龄）尚不明确有关（此处：年龄大于75岁）。进一步的指标可衡量首选药物的处方，避免风险组合和具有成本意识的处方。指标将在处方分析中介绍，并将在小组会议上进行讨论。结果：主持人平均将34％的降脂药用于一级预防，GP圈参与者则占36.7％。平均而言，主持人和全科医生参加降脂药物的年龄分别超过75岁的患者分别为4.9％和7.5％（一级预防中为6％和22％）。参与者发行的所有降脂药物中约有28％涉及辛伐他汀和普伐他汀作为首选药物，而主持人则为36.5％。他汀类药物与贝特类或大环内酯类合用的处方很少。可以通过通用处方的百分比和每个活性剂不同品牌的数量来评估每个GP的成本意识处方。主持人和参与者在处方贝特类，胆汁酸螯合剂或其他类型的降脂药时都使用了仿制药（主持人为53.8％，全科医生为78.5％）。三个月对于评估降脂药物处方的依从性来说太短了。结论：有可能从指南中得出指标并将其整合到处方分析中。指标揭示了处方问题。 2002年对PTC的评估将涉及使用指标作为评估准则实施成功与否的工具。

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