An Epidemiologic Approach to Drug Prescribing Quality Assessment

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

• Rationalising prescribing

  Open Access•Sarah Wadmann, Lia E Bang•Social Science & Medicine•2015

  Incluir item

• Drug Utilization Review in Ambulatory Settings

  Helene Levens Lipton, Joyce Adair Bird•Medical Care•1993

  Incluir item

• Inappropriate drug prescriptions for elderly residents of board and care facilities

  Diana L Spore, Vincent Mor et al.•American Journal of Public Health•1997

  Incluir item

• Ability to Pay and the Decision to Medicate

  Bruce Stuart, James Grana•Medical Care•1998

  Incluir item

• Gender Differences in the Acquisition of Prescribed Drugs

  Bonnie L Svarstad, Paul D Cleary et al.•Medical Care•1987

  Incluir item

• Gender and Psychotropic Drug Use

  Jane M Simoni, Linda Simoni-Wastila•Medical Care•1998

  Incluir item

• Gender Bias in Psychotropic Drug Prescribing in Primary Care

  Ann A Hohmann•Medical Care•1989

  Incluir item

• Physician motivations for nonscientific drug prescribing

  Open Access•Rebecca K Schwartz, Stephen B Soumerai et al.•Social Science & Medicine•1989

  Incluir item

• Gender, employment and medication use

  Open Access•Maria Zadoroznyj, Bonnie L Svarstad•Social Science & Medicine•1990

  Incluir item