Qualidade na Atenção Primária Acesso livre

Abstrato

Application of evidence-based prescribing indicators in primary care: a pilot

SH Guptha

Background Quality of prescribing is an important clinical governance issue. Current indicators of prescribing in primary care are not accurate in measuring the quality of prescribing as they are based on overall levels of prescribing without any link to clinical data of patients. We have developed a number of prescribing indicators that are linked to clinical data of elderly patients admitted tosecondary care facilities. We studied the applicability of these secondary care prescribing indicators to primary care, to measure the quality of prescribing in elderly patients and to assess the e¡ects of educational intervention in improving the quality of prescribing.Methods This was a longitudinal open intervention study in a single practice. Computerised prescribing data for all patients 65 years and over were collected before and after intervention. Indicators included purely descriptive data as well as clinical appropriateness data. Clinical data for assessing the appropriateness of prescribing were collected from general practitioner (GP) case notes. Data were collected and recorded using a customised Microsoft access database.Results Five out of the 14 indicators were not applicable in the primary care setting due to idiosyncrasies of computerised prescribing data, medical record keeping and deŽ ciencies in the data entry software. Following the intervention, generic prescribing improved from 85 to 93% (P = 0.002), documentation of frequency of as required (prn) items improved from 60 to 81% (P < 0.001), the appropriate use of benzodiazepines improved from 46 to 63% (not signiŽ cant [NS] ) and that of b2 agonist/steroid use from 85 to 90% (NS). The appropriate use of antithrombotics in atrial Ž brillation remained at 73% and the appropriate use of aspirin in ischaemic heart disease fell from 77 to 75% (NS).Conclusions Some modiŽ cations were required to increase the applicability of hospital inpatient indicators in primary care. However all indicators of appropriate prescribing were applicable toprimary care allowing an accurate measurement of quality of prescribing. There was a trend towards improvement in most indicators following intervention, resulting in improved quality of prescribing, but the use of aspirin in ischaemic heart disease could have been a¡ected di¡erentially in the two data collections by the use of over-thecounter aspirin not showing in the prescribing data