[Comparison of two models of prescription quality indicators in primary care].
OBJECTIVE
To assess the quality of prescriptions in primary care area through indicators established by a team of physicians and to analyze the relationship between these indicators and those used by the Spanish public health system (INSALUD) in the same area.


METHODS
An observational, cross sectional study was performed in a primary care area in Asturias with 156,614 inhabitants and 9 health centers. An overall quality score was obtained for each of the physicians in the primary care area by using quality indicators and standards agreed on by the prescribers themselves. The relationship between the score obtained and the indicators normally used in the area by INSALUD and pharmaceutical cost was also analyzed.


RESULTS
Mean compliance with the optimal standard was 29%. The mean overall quality score was 3.24. None of the physicians achieved the maximum score of 11. No significant association was found between the score and the indicators for drugs of limited clinical value. Adherence to the pharmaceutical guide for the area was positively correlated with quality (r = 0.44, p < 0.001). A negative linear association (p < 0.001) was found between the overall quality score and incurred cost. The adjusted coefficient of determination was 0.29.


CONCLUSIONS
Poor prescribing quality was widespread. Indicators for drugs of limited clinical value, frequently used as a measure of quality, showed no relationship with quality. Adherence to the area's pharmaceutical guide remains a valid indicator of prescribing quality. Overall, there was a correlation between higher quality and lower prescribing cost, although this correlation was not found for individual physicians.
Departamento de Medicina. Area de Medicina Preventiva y Salud Pública. Universidad de Oviedo. Oviedo. España. mjgc@telecable.es
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Gómez-Castro
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Arcos
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Rubiera
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Rigueira
D002391:Catchment Area, Health; D003430:Cross-Sectional Studies; D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D008962:Models, Theoretical; D009313:National Health Programs / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D013030:Spain