Coordinator research program Care Demand of the Chronically Ill and Disabled; honorary professor 'Pharmacy health services research', University of Groningen, the Netherlands
Publicatie
Adherence to prescription guidelines in general practice: inter-doctor variation and trends over time.
Dijk, L. van, Jong, J.D. de, Spreeuwenberg, P.M.M., Berg, M. van den, Westert, G.P., Bakker, D.H. de. Adherence to prescription guidelines in general practice: inter-doctor variation and trends over time. Pharmacoepidemiology and Drug Safety: 2009, 18(suppl. 1), p. S 146. Abstract. 25th International Conference 'Pharmacoepidemiology and Therapeutic Risk Management'. Providence, 16-19 augustus 2009.
Background: Evidence-based working has become increasingly important in medical care. A growing number of clinical guidelines has been implemented aiming at improving quality of care and decreasing inter-doctor variation. Objectives: To describe trends in adherence to prescription guidelines of the Dutch College of General Practitioners (NHG) and to study inter-doctor variation over a 5-year period (2003–2007). Methods: Data were used from routine electronic medical
records from 80 representative general practices in the Netherlands (LINH), including around two million diagnosis- coded prescriptions per year. These data were combined with electronic data from the NHG-guideline database. Per diagnosis (ICPC-coded) we determined the percentage of prescriptions that included a drug that recommended for that particular diagnosis. To determine inter-doctor variation 95% confidence-intervals were calculated using multilevel analyses. Multilevel analyses were also used to test trends in guideline adherence over time. Results: A trend in guideline adherence (either upwards or downwards) was found for a minority of diagnoses. Adherence levels varied considerably between diagnoses. For example, while GPs chose a recommended drug in <5% of the prescriptions for acute bronchitis and incontinence, they chose >85% of recommended drugs for enuresis and constipation. Guidelines for the respiratory system generally have low adherence. Inter-doctor variation was large for all diagnoses, but constant over time. Conclusions: Guideline adherence is constant over time, but varies across guidelines and GPs. Efforts to rationale prescribing should focus on a selection of diseases with a low level of guideline adherence combined with risks for patient safety such as diseases of the respiratory system.
records from 80 representative general practices in the Netherlands (LINH), including around two million diagnosis- coded prescriptions per year. These data were combined with electronic data from the NHG-guideline database. Per diagnosis (ICPC-coded) we determined the percentage of prescriptions that included a drug that recommended for that particular diagnosis. To determine inter-doctor variation 95% confidence-intervals were calculated using multilevel analyses. Multilevel analyses were also used to test trends in guideline adherence over time. Results: A trend in guideline adherence (either upwards or downwards) was found for a minority of diagnoses. Adherence levels varied considerably between diagnoses. For example, while GPs chose a recommended drug in <5% of the prescriptions for acute bronchitis and incontinence, they chose >85% of recommended drugs for enuresis and constipation. Guidelines for the respiratory system generally have low adherence. Inter-doctor variation was large for all diagnoses, but constant over time. Conclusions: Guideline adherence is constant over time, but varies across guidelines and GPs. Efforts to rationale prescribing should focus on a selection of diseases with a low level of guideline adherence combined with risks for patient safety such as diseases of the respiratory system.
Background: Evidence-based working has become increasingly important in medical care. A growing number of clinical guidelines has been implemented aiming at improving quality of care and decreasing inter-doctor variation. Objectives: To describe trends in adherence to prescription guidelines of the Dutch College of General Practitioners (NHG) and to study inter-doctor variation over a 5-year period (2003–2007). Methods: Data were used from routine electronic medical
records from 80 representative general practices in the Netherlands (LINH), including around two million diagnosis- coded prescriptions per year. These data were combined with electronic data from the NHG-guideline database. Per diagnosis (ICPC-coded) we determined the percentage of prescriptions that included a drug that recommended for that particular diagnosis. To determine inter-doctor variation 95% confidence-intervals were calculated using multilevel analyses. Multilevel analyses were also used to test trends in guideline adherence over time. Results: A trend in guideline adherence (either upwards or downwards) was found for a minority of diagnoses. Adherence levels varied considerably between diagnoses. For example, while GPs chose a recommended drug in <5% of the prescriptions for acute bronchitis and incontinence, they chose >85% of recommended drugs for enuresis and constipation. Guidelines for the respiratory system generally have low adherence. Inter-doctor variation was large for all diagnoses, but constant over time. Conclusions: Guideline adherence is constant over time, but varies across guidelines and GPs. Efforts to rationale prescribing should focus on a selection of diseases with a low level of guideline adherence combined with risks for patient safety such as diseases of the respiratory system.
records from 80 representative general practices in the Netherlands (LINH), including around two million diagnosis- coded prescriptions per year. These data were combined with electronic data from the NHG-guideline database. Per diagnosis (ICPC-coded) we determined the percentage of prescriptions that included a drug that recommended for that particular diagnosis. To determine inter-doctor variation 95% confidence-intervals were calculated using multilevel analyses. Multilevel analyses were also used to test trends in guideline adherence over time. Results: A trend in guideline adherence (either upwards or downwards) was found for a minority of diagnoses. Adherence levels varied considerably between diagnoses. For example, while GPs chose a recommended drug in <5% of the prescriptions for acute bronchitis and incontinence, they chose >85% of recommended drugs for enuresis and constipation. Guidelines for the respiratory system generally have low adherence. Inter-doctor variation was large for all diagnoses, but constant over time. Conclusions: Guideline adherence is constant over time, but varies across guidelines and GPs. Efforts to rationale prescribing should focus on a selection of diseases with a low level of guideline adherence combined with risks for patient safety such as diseases of the respiratory system.
Gegevensverzameling
