[Factors relating to the cost and quality of drug prescriptions in primary care]

Abstract

Objectives: To analyse, quantitatively and qualitatively, the pharmaceuticals prescribed by doctors within two models of Primary Care: the reformed (RM) and non-reformed (NRM). To study which variables of the doctor, work-centre or community attended explain prescription variations.

Design: An observational crossover study.

Setting: Primary Health Care centres in the province of Málaga.

Participants: The prescriptions of 454 doctors were studied: 259 RM and 195 NRM. A univariant analysis was performed on the indicators of prescription of both health-care models, with afterwards a multiple linear regression analysis to study the effect of the rest of the variables.

Results: There were differences in two of the quantitative indicators studied, with more prescriptions and expense per insured person per day in the NRM, as well as higher prescription for several therapeutic groups, mainly of drugs against flu, and also of drugs against infections, tonics, restoratives and capillary protectors. The variables which best explained prescriptions in the multivariant analysis were: consultations per insured person per day and the percentage of pensioners on the doctor's list.

Conclusions: We thought that the differences between the two health-care models in the quantitative analysis were of very little relevance. They were greater in the qualitative one and suggested higher quality of prescription in the RM. Pressure of numbers was identified as, among the studied variables, that which best explains prescription, over and above others like the health-care model or medical training. As for the percentage of pensioners on the doctor's list, it should be borne in mind at the hour of evaluating his/her prescriptions.