[Underprescription of iron and clinical practice variability at the primary care level of public medical attention in Argentina].
Iron deficiency and anemia have a very high prevalence and serious consequences for infants and pregnant women. Since late 2002, the Remediar Program provided free iron to the vulnerable population. Question arises whether free provision favors access to the drug.


OBJECTIVE
To describe the iron prescription frequency at the primary care level in Argentina, and to estimate variability in clinical practice.


METHODS
Retrospective observational study based on the Remediar Program with cross comparisons of diagnosis and prescriptions by individual provinces and centers. The Program's prescriptions forms constitute the secondary sources of information. The target population of the study is the universe of infants and women in fecund age that were attended in 6,000 centers encompassing 24 Argentine provinces between March of 2005 and February of 2006.


RESULTS
Fifteen million prescriptions were reviewed. Only in one out of every 25 infant consultations and in one of every 71 women of child bearing age prescriptions iron is prescribed through Remediar. Provided diagnoses are more associated with treatment of, than prevention of, anemia. The likelihood of prescribing iron varies up to four fold depending on the facility and the province where the medical visit takes place.


CONCLUSIONS
Underprescription of iron generates difficulties in patient access to an essential drug. Variability in medical practice may be a possible cause of unequal medical care.
Bernztein
Ricardo
R
Médico pediatra del Hospital Garrahan, Consultor Area Asistencia Técnica Programa Remediar, Ministerio de Salud de la Nación. rbernz@intramed.net
Drake
Ignacio
I