[Factors conditioning prescription in primary care].
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Biomedical subjects
Publications and source records attributed to F Caamaño.
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OBJECTIVES: The objective of the study was to evaluate the effectiveness of 2 educational strategies aimed at improving prescribing standards in primary care. METHODS: A pragmatic controlled trial was designed; the study population included general and family practitioners in Galicia (northwestern Spain) divided into 3 study groups: a one-to-one education group (n = 98), a by-group education group (n = 92), and a control group (n = 405). The educational intervention included explicit recommendations for selecting nonsteroidal anti-inflammatory drugs (NSAIDs) for inflammation signs. Some of the subjects were given reminders. Mixed-effect linear models were applied to data analysis. Analyses were done by intention-to-treat. The dependent variable is a rate with a numerator that is the number of prescribed units of the NSAIDs recommended during intervention; the denominator is the total number of prescribed units of the NSAID total. RESULTS: One-to-one education obtained an average prescribing behavior improvement of 6.5% (P < 0.001) in the 9 months after intervention. In the education group, the average improvement was 2.4% (P < 0.05) for the same period. Statistically significant differences were observed between the group intervention and one-to-one groups. The reminder increased significantly the effectiveness of the one-to-one intervention. CONCLUSIONS: A single, short educational session to primary care doctors can improve their prescribing standards during long periods of > or = 9 months. Of the 2 strategies followed in the trial, one-to-one education has shown to be the most effective. Results also show that the effectiveness of these interventions increases when presented together with written material.
OBJECTIVE: To identify factors associated with low prescription quality in primary care. METHODS: We carried out a cross-sectional study on a sample of 405 primary care physicians in Galicia (Northwest Spain). The following independent variables were collected through a mail questionnaire survey: physician's education and speciality, physician's perception of the quality of available drug information sources, type of practice and number of patients. We constructed multiple regression models using as dependent variables four indicators of the quality of drugs prescribed. RESULTS: The response rate was 75.2%. The quality of drugs prescribed was found to be associated with regulated physician training (P = 0.001), perceived credibility of information sources (P = 0.013) and environmental characteristics of the practice (reform model and number of patients' cards). CONCLUSION: Study results suggest that in order to improve the quality of drugs prescribed, physician education and training must be improved and the role of pharmaceutical companies in physician training should be limited, emphasising more objective sources of information, such as therapeutic guidelines. Our results also underline the need to complete the reform of our primary care system and promote better relationships among physicians and between physicians and patients.
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To identify the sociodemographic factors associated to self-medication (i.e. use of non-prescription medicines) and undesirable self-medication, a cross-sectional study was carried out using a sample (n = 20,311) representative of the population of adults of 16 years of age and older in Spain. Multivariate Cox's regression was used. The prevalence of self-medication in the sample was 12.7% during the two weeks preceding the interview. Self-medication is more prevalent among women, persons who live alone, and persons who live in large cities. For persons who reported acute disorders, self-medication prevalence was higher among those with higher educational levels. The prevalence of undesirable self-medication in the sample was 2.5% during the two weeks previous to the interview. Undesirable self-medication is twice as common among persons older than 40 years, as compared to persons younger than 27 years. Undesirable self-medication prevalence is 53.0% higher among those who live alone as compared to those who live with their partner (95% confidence interval (CI): 15.2-103.2) and 36.8% higher among students as compared to full-time workers (95% CI: 1.9-83.5). People over 40 years of age, people living alone, and students should be the priority target populations for public health education programs aimed at improving the quality of self-medication behavior.
Self-medication constitutes one of the most modern expressions of the always present need of men and women for care of their health. However, in contrast to other expressions of selfcare, the self-medication includes, for a good part of population and the most of the doctors, negative connotations. Contrary to this vision, the WHO marks the existence of a valid role for self-medication in developed societies. This article has two objectives: to revise the different concepts of self-medication proposed in literature; and to revise the socio-demographic and socio-medical factors connected with the practice of self-medication.
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OBJECTIVE: To identify the explanatory variables of avoidable cost produced by not prescribing a cheaper equivalent drug. METHODS: We conducted a cross-sectional study of 1,500 primary care physicians in Galicia (northwest Spain). The sample consisted of 405 primary care physicians. The following independent variables were collected through a postal questionnaire physicians' training and specialty, physicians' perception of the quality of available drug information sources, type of practice, and number of patients. The environmental characteristics of the practice were obtained from secondary sources. Multiple regression models were constructed using as dependent variables two indicators based on unnecessary cost produced by not prescribing cheaper equivalents. RESULTS: The response rate was 77,4%. No association was found between prescription efficiency and the level of the physician's training, or with the variables of utilization or the quality of commercial and institutional information. The variable of health model was not significant. The only statistically significant variables were the number of identification cards and the percentage of pensioners' identification cards. CONCLUSIONS: The results of this study suggest that physicians attach little importance to prescription efficiency. Thus, to decrease avoidable cost produced by not prescribing a cheaper equivalent drug, the medical curriculum should be modified to ensure that is contents reflect national health priorities and current resources.
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