Abstract
In the south west region of Stockholm a group of 125 general practitioners (GPs) at 27 health centres asked about the extent to which the drug formulary of the University Hospital was useful in their practices. To answer this question, the GPs asked their local pharmacies for prescribing data.
When presented this started a process towards rational prescribing from within the group of GPs, including repeated prescribing surveys, starting with health centres as the unit of analysis and proceeding to individual prescribing analyses on request by the GPs.
As the prescribing data revealed major differences between health centres, the GPs arranged two workshops on drug use in primary health care. They developed a list of 167 recommended drugs based on drug statistics and morbidity in general practice. Signs of increased cost cautiousness could be shown.
There was a clear trend towards both smaller volumes and cost per prescription item for the health centres in the study area. Compared to the national prescribing pattern, prescribing practice in the study area represented a 20 per cent lower drug cost.
Although the GPs decided on a drug list separate from that of the hospital, collaboration between the Drug and Therapeutic Committee at the hospital and the GPs increased as a result of their increased engagement in drug management, thereby also bridging the gap between primary health care and clinical pharmacology.
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References
Mölstad S, Hovelius B, Kroon L, Melander A (1990) Prescription of antibiotics to out-patients in hospital clinics, community health centres and private practice. Eur J Clin Pharmacol 39: 9–12
McGavock H (1991) Peer-review of GP prescribing in N. Ireland — techniques and results. In: Auditing drug therapy — approaches towards rationality at reasonable costs. Swedish Pharmaceutical Press, Stockholm, pp 93–103
Anonymous (1987) The rational use of Drugs. WHO Report of the Conference of Experts, Nairobi 25–29 November 1985, WHO, Geneva
Agenäs I (1985) Consensus om läkemedelsinformation i primärvården. (Consensus on drug information in primary health care). Läkartidningen 82: 510–511
Tomson G (1991) Drug utilization and people. A Swedish perspective. Ann 1st Super Sanità 27: 239–246
Avorn J, Chen M, Hartley R (1982) Scientific versus commercial sources of influence on the prescribing behaviour of physicians. Am J Med 73: 4–8
Swedish Drug Statistics (1987–1990) National Corporation of Swedish Pharmacies, Stockholm.
Block I, Svender O (1986) Läkemedelsutbildning för distriktsläkare. (Postgraduate education for GPs about drugs), Läkartidningen 83: 666–667
Sjöqvist F, Boethius G (1986) Attitudes to development of drug therapy in Scandinavia. Br J Clin Pharmacol 22: 19s-26s
Beermann B, Lundberg G (1985) Läkare i öppen vård minst följsamma till läkemedelskommittéernas rekommendationer. (Primary health care physicians show the least complience to the recommendations from the DTC.) Läkartidningen 82: 508–510
Hammarström B, Westerholm B (1988) Pharmacists to the fore. World Health Forum 9: 514–518
Tomson G, Holmberg K, Häggmark A, Tomson Y, Westerholm B (1990) Fran statistik till handling: förskrivning av läkemedel i primärvården. (From statistics to action: drug prescribing in primary health care). Läkartidningen 87: 1483–1484
Diwan VK, Eriksson B, Sterky G, Tomson G (1992) Randomization by group in studying the effect of drug information in primary care. Int J Epidemiol 21: 124–130
Wessling A (1987) Continuous recording of drug prescribing in Sweden 1974–1983 Methods and examples of utilization of data. Eur J Clin Pharmacol 33: 7–13
Lee D, Bergman U (1989) Studies of drug utilization. In: Stroem BL (ed) Pharmacoepidemiology. Churchill Living-stone, New York, pp 259–274
Anonymous (1992) Nätverk för Läkemedelsepidemiologi NEPI (Network for pharmacoepidemiology) Report. Ministry of Health and Social Welfare, Stockholm, p 104
Grimshaw JM, Russel IT (1993) Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet II: 1317–1322
Soumerai SB, McLaughlin TJ, Avorn J (1990) Quality assurance for drug prescribing. Quality Assurance Health Care 2: 37–58
Crooks J (1978) Methods of audit in drug use. In: Duchène Marullaz P (ed) Advances in pharmacology and therapeutics. Proceedings of the 7th International Congress on Pharmacology, vol 6, Clinical Pharmacology, Paris, pp 189–195
McGavock H (1988) Some patterns of prescribing by urban general practitioners. Br Med J 296: 900–902
Grant GB, Gregory DA, Swanenberg TD van (1985) Development of a limited formulary for general practice. Lancet I: 1030–1032
Sjöqvist F (1992) Auditing drug therapy, why and how? In: Auditing drug therapy. Approaches towards rationality at reasonable costs. Swedish Pharmaceutical Press, Stockholm, pp 28–34
Dukes G, Lunde PK, Melander A, Orme M, Sjöqvist F, Tognoni G, Wesseling H (1990) Clinical pharmacology and primary health care in Europe — a gap to bridge. Eur J Clin Pharmacol 38: 315–318
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Tomson, Y., Wessling, A. & Tomson, G. General practitioners for rational use of drugs. Eur J Clin Pharmacol 47, 213–219 (1994). https://doi.org/10.1007/BF02570500
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DOI: https://doi.org/10.1007/BF02570500