Development of NSAIDs prescription indicators based on health outcomes.
OBJECTIVE
To explore the relationship between prescribing indicators aimed at assessing the prescribing quality of general practitioners (GPs) and indicators of health outcomes at the population level.


METHODS
Ecological study.


METHODS
Aljarafe Primary Health Care Area (population 321,034), part of the Andalusian Public Health Care Service, Spain. A total of 162 GPs, representing 95.29% of the total GPs in the study area, participated in the analysis.


METHODS
The prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) was determined using evidence-based indicators chosen by the consensus group technique. Admissions to hospitals in the study area due to digestive ulcer, bleeding or perforation were recorded. Multivariate regression analysis was then carried out to determine both the amount of variation in hospital admissions that can be explained by a combination of prescribing indicators and the strength and direction of independent associations with individual indicators.


RESULTS
The higher prescription of NSAIDs adjusted for patients and working days (p = 0.002) and the higher relative prescription of gastroprotective agents versus NSAIDs (p < 0.001) were associated with a higher number of adjusted hospital admissions due to gastrointestinal adverse events (coefficient of correlation R = 0.378). In addition, the higher number of prescriptions for analgesics than for NSAIDs was related to fewer admissions (p = 0.028). There were fewer patients of GPs with postgraduate training admitted to hospital for these complaints (p = 0.049).


CONCLUSIONS
The risk of hospitalization for serious gastrointestinal adverse events can be partially linked to the prescribing of NSAIDs based on an analysis of the prescribing indicators. A higher prescribing of NSAIDs was associated with significantly higher admissions. This relationship was not found for indicators based on the relative use of some NSAIDs versus total NSAIDs or on the use of gastroprotective drugs.
Fernández Urrusuno
Rocío
R
Aljarafe Primary Health Care Area, Seville, Spain.
Pedregal González
Miguel
M
Torrecilla Rojas
Ma Amparo
MA
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D004503:Education, Medical, Graduate; D019317:Evidence-Based Medicine; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010821:Physicians, Family / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D013030:Spain
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents