An Epidemiologic Approach to Drug Prescribing Quality Assessment

A Study in Primary Care Practice in France

Bibliographic Data

ID9104879
AuthorsJoël Coste (0000-0001-7674-7192, Université Paris Cité, corresponding author), Alain Venot (0000-0002-6842-2512, Université Paris Cité)
Year1999
Volume37
Issue12
Pages1294-1307
Publication date1999-12-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/00005650-199912000-00012
PMID10599610
OpenAlexW2325909723
LanguageEN
Citations received1
References cited36

OBJECTIVE: To assess drug prescribing by primary care physicians in France for various types of conditions, and to identify patterns and risk factors for poor prescribing quality. METHODS: The orders (n = 23,080) written for patients with five target diseases (acute nasopharyngitis, acute tonsillitis, essential hypertension, osteoarthrosis, and back and periarticular disorders), by primary care physicians (n = 1,049) were extracted from a nationwide prescription database and analyzed according to 17 quantitative indicators of drug prescribing quality constructed on explicit a priori criteria. RESULTS: Ineffective drugs were prescribed in 32% to 88% of orders according to the target disease. Six percent to 40% of orders resulted in drug interactions, age problems, and overdosage. A consistent pattern of associations between indicators was found, which suggests that drug prescribing quality is multidimensional and is composed of at least five dimensions: placebo, novelty, exoticism, misdosage, and interaction. Several factors associated with indicators were also identified, some of them defining groups of patients at risk (women, elderly, and less educated), physicians at risk (women, aged, and isolated), and contexts at risk (patient's home and disease frequently treated by the physician) of poor drug prescribing quality. CONCLUSIONS: Drug prescribing by French primary care physicians appears nonoptimal, in terms of both risk of iatrogeny and waste of money. This study further documents the complexity and the multidimensionality of drug prescribing quality. It suggests that more attention must be paid to patients' and physicians' risk factors for poor drug prescribing quality if educational programs and regulatory processes are to succeed in promoting safer and more cost-effective practices

Disease · Drug · Family medicine · Intensive care medicine · Medical prescription · Quality (philosophy) · Antibiotic Use and Resistance · Internal Medicine · Medicine · Pharmaceutical Practices and Patient Outcomes · Pharmacology · Pharmacovigilance and Adverse Drug Reactions