Evaluation of the proper use of medicines in primary care. How can this be improved?

Abstract

Introduction. The process of medicating a patient embraces the identification of the health problem, the doctor's prescription to treat this indication, the dispensing of the medicine and its consumption. The studies of use of medicine analyse this process in order to detect those factors that impinge on the correct use of medicines. Objective. To evaluate the quality of the prescription of certain primary care medicines as a function of the indication for which they were prescribed, detecting those features of the patients, prescribing doctors, primary care centre and health district that affect their inappropriate use. Method. Prescription-indication study based on the calculation of multiple-level models with individualised data bases for the prescriptions. These include characteristics of the prescriptions, patients, doctors, health centres and the health district involved. These models are a step forward in this kind of study, in that they enable analysis of the information from different levels at the same time as calculation of the respective «degrees of responsibility» for inadequacies of prescription. Discussion. Apart from its methodological originality, which may serve for subsequent studies, the main interest of this study lies in the pioneering nature of its massive use of population micro-data to evaluate prescription quality. These data are taken from the computerised clinical records in primary care.