Management by objectives and its impact on specialist prescription quality at discharge and in external consultations.
OBJECTIVE
To verify that implementing a policy of management by objectives, based on collaboration between hospital pharmacy, primary care and specialised medical managers, improves prescription quality indicators in specialised care and reduces unwanted "induced" prescriptions (i.e. those issued by specialists, hospital doctors or the patients themselves) in primary care.


METHODS
A four year quasi-experimental controlled intervention study on prescription at discharge and in outpatient hospital consultations was conducted. In hospital A, a quality cycle was applied: assessment, identifying improvement opportunities, implementing corrective actions and re-assessment. However, it was not applied in control hospital B. The indicators chosen were the percentage of generic medicines prescribed, the percentage of prescriptions for new therapies with no added value and the percentage of prescriptions for ACE inhibitors recommended.


RESULTS
In hospital A, an increase in indicators 1 and 3 has been observed, both being statistically significant, between the last year of intervention and the year previous to intervention. Hospital A managed to reduce indicator 2 to 4.5%, while this indicator increased in hospital B to 8.8%. Furthermore, a statistically significant difference in indicators between the two hospitals has been registered.


CONCLUSIONS
Pay-for-Performance programs in prescription practices of hospital physicians are effective actions to improve quality indicators of medication use.
Olmo
M
M
Servicio de Farmacia, Hospital Universitari Arnau de Vilanova, Lleida, España.
Galvan
L
L
Capdevila
J
J
Serna
C
C
Mangues
I
I
Schoenenberger
J A
JA
D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004363:Drug Utilization; D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use; D016304:Hospitals, Private / Q000458:organization & administration; D006779:Hospitals, Public / Q000458:organization & administration; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000706:statistics & numerical data; D054539:Medication Therapy Management / Q000458:organization & administration*; D008511:Medicine; D016134:Organizational Policy; D010351:Patient Discharge; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012052:Reimbursement, Incentive; D013030:Spain
D000806:Angiotensin-Converting Enzyme Inhibitors; D016568:Drugs, Generic