Objective: To evaluate and improve generic drug prescription by family physicians in a regional primary care district with a specially-designed intervention.
Design: Uncontrolled study of an intervention, based quality evaluation and improvement methods. We selected an indicator that could be constructed with the available data (monthly reports of prescriptions dispensed through the public national health system) and determined the proportion of prescriptions for generic drugs to the total number of prescriptions dispensed, for those medications that had a generic alternative (percentage of generic prescriptions, PGP). After these data were evaluated, an intervention was implemented to increase generic prescriptions. Prescribing behavior was again evaluated and monitored at the end of the intervention period. Setting. Forty-five primary care teams in the Murcia (Southeast Spain) regional primary care district.
Participants: A total of 339 family physicians. Interventions. During 15 months, individual reports of prescribing practices, in which changes over time were graphed, were sent to each participating prescriber. Each semester the physicians received a personal letter and a specially-printed, updated card showing the generic medications available and their pharmaceutical forms. One to three face-to-face clinical outreach sessions were held with each primary care team. Specific prescribing goals for the PGP were set and incentives to attain the goals were included in the terms of the contract for clinical services signed between the regional office of primary care management and each primary care team.
Main outcome measures: The PGP increased from a pre-intervention rate of 2.7% to a post-intervention rate of 17.63%. Absolute improvement was therefore 14.84%, and relative improvement was 15.27%. Variability was monitored and analyzed with control charts. There was no significant variability within the pre- and post-intervention phases, whereas variability increased significantly (indicating improvement) during the intervention phase.
Conclusions: The increase in PGP showed that prescribing for generic preparations improved. Statistical quality control tests were useful in evaluating and tracking the results of the intervention, and were indispensable for monitoring and promptly detecting opportunities to improve prescribing behavior and take appropriate measures.
Objetivo: Evaluar y mejorar la prescripción de medicamentos genéricos por los médicos de familia de una gerencia de atención primaria (GAP) mediante un programa de intervención.
Diseño: Estudio de intervención no controlado, basado en la metodología de evaluación y mejora de la calidad. Seleccionamos un indicador capaz de ser construido con los datos disponibles (cinta de facturación), eligiendo la proporción de genéricos prescritos sobre el total de envases en que existe alternativa genérica (PPEFG). Evaluamos, diseñamos una intervención para mejorar, reevaluamos y monitorizamos.
Emplazamiento: Cuarenta y cinco EAP de la GAP de Murcia.
Participantes: Un total de 339 médicos de familia.
Intervenciones: Realizadas durante 15 meses, fueron: remisión de informe mensual personalizado mostrando la evolución del PPEFG mediante gráficos de desarrollo; edición y entrega personalizada semestral de una tarjeta con los medicamentos genéricos disponibles y sus presentaciones; realización de 1–3 sesiones/EAP, e inclusión de un objetivo en PPEFG explícito e incentivado en los contratos de gestión.
Mediciones y resultados principales: El PPEFG preintervención fue del 2,79% y el postintervención de un 17,63%. La mejora absoluta es del 14,84% y la relativa de un 15,27%. Se ha monitorizado y analizado la variabilidad mediante gráficos de control. No se detecta variabilidad significativa en las fases pre y postintervención y sí (hacia la mejora) durante la intervención.
Conclusiones: Ha mejorado la prescripción de genéricos medida en PPEFG. Las técnicas de control estadístico de la calidad aplicadas son útiles en la evaluación y seguimiento de la intervención e imprescindibles para monitorizar, detectar precozmente oportunidades de mejora y actuar en consecuencia.