Abstract:
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.
journal_name
Med Carejournal_title
Medical careauthors
Coste J,Venot Adoi
10.1097/00005650-199912000-00012keywords:
subject
Has Abstractpub_date
1999-12-01 00:00:00pages
1294-307issue
12eissn
0025-7079issn
1537-1948journal_volume
37pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract::Current health care system reform proposals center on reducing the number of uninsured by extending private health insurance coverage. Discussion has also included enrolling Medicaid recipients in private programs. Much of the deliberation concerning extending coverage has centered on cost, but largely has not address...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199403000-00004
更新日期:1994-03-01 00:00:00
abstract:BACKGROUND:Since COVID-19 has caused dramatic changes in everyday life, a major concern is whether patients have adequate access to mental health care despite shelter-in-place ordinances, school closures, and social distancing practices. OBJECTIVES:The aim was to examine the availability of telehealth services at outp...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001512
更新日期:2021-01-21 00:00:00
abstract:PURPOSE:To explore whether there was a significant relationship between difficulty paying for ostomy supplies and overall quality of life among a sample of ostomates receiving care from the Veterans Health Administration (VHA). METHODS:The data were collected as part of the Veterans Affairs (VA) Ostomy Health-Related ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318074ce9b
更新日期:2007-09-01 00:00:00
abstract:BACKGROUND:Reference drug pricing (RP) is a cost-sharing strategy commonly used to control drug expenditures. Under RP, a benefit plan fully reimburses medications that are equally or less expensive than the reference price, and requires patients to pay the extra cost of therapeutically equivalent but higher priced dru...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000129497.10930.a2
更新日期:2004-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Hospital-acquired catheter-associated urinary tract infection (CAUTI) is one of the first 6 conditions Medicare is targeting to reduce payment associated with hospital-acquired conditions under Congressional mandate. This study was to determine the positive predictive value (PPV) and sensitivit...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31818af83d
更新日期:2009-03-01 00:00:00
abstract:BACKGROUND:The negative impact of pain on health-related quality of life has been documented for persons with human immunodeficiency virus (HIV). Furthermore, pain could be an important factor in seeking medical care. However, the relationship between pain and health service utilization is poorly understood. OBJECTIVE...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000108744.45327.d4
更新日期:2004-02-01 00:00:00
abstract:BACKGROUND:Breast cancer missed on diagnostic mammography may contribute to delayed diagnoses, whereas false-positive results may lead to unnecessary invasive procedures. Whether accuracy of diagnostic mammography at facilities serving vulnerable women differs from other facilities is unknown. OBJECTIVE:To compare the...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181f380e0
更新日期:2011-01-01 00:00:00
abstract::Cataract surgery is the most frequently performed surgical procedure on Medicare beneficiaries, with an annual cost to the Medicare program of more than $3.4 billion. In this study, the relationship between demographic, environmental, and provider-related factors, and the likelihood that cataract surgery will be perfo...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199501000-00008
更新日期:1995-01-01 00:00:00
abstract:BACKGROUND:Several organizations are advocating for patients' preferences to be considered in clinical practice guideline development and implementation. However, lack of agreement on the goal and meaning of this policy curtails evaluation and development of patient involvement programs. GOAL:To describe guideline dev...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181a81158
更新日期:2009-08-01 00:00:00
abstract:BACKGROUND:Many national surveys have found substantial differences in self-reported overall health between Spanish-speaking Hispanics and other racial/ethnic groups. However, because cultural and language differences may create measurement bias, it is unclear whether observed differences in self-reported overall healt...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31820fb944
更新日期:2011-05-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to determine whether parents rate their children's care differently when they also rate their own care than when they do not. METHODS:Subjects were employees of Washington State who had been enrolled in a health plan for at least 6 months and who had at least one covered child. Sub...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005650-199903001-00007
更新日期:1999-03-01 00:00:00
abstract:BACKGROUND:Understanding barriers to health care access experienced by people with disabilities who are members of underserved racial/ethnic groups is key to developing interventions to improve access. OBJECTIVE:To conduct a scoping review of the literature to examine the published literature on barriers to health car...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/MLR.0000000000000195
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:Increasing surgical access to previously underserved populations in the United States may require a major expansion of the use of operating rooms on weekends to take advantage of unused capacity. Although the so-called weekend effect for surgery has been described in other countries, it is unknown whether US...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000532
更新日期:2016-06-01 00:00:00
abstract::To explore the reliability of Medicare Part A claims data for clinical and health services research related to the care of patients with cancer, the authors compared estimates of the incidence of and resection rates for cancer of the breast, colon, and lung derived from analysis of Medicare Part A data versus data fro...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199112000-00005
更新日期:1991-12-01 00:00:00
abstract::Seven general surgeons in a prepaid group practice previously shown to have a mean operative work load of 9.2 hernia equivalents (HE) per week were found to have a standardized mean daytime working week of 56.2 hours, exclusive of evening activities of which 50.7 hours were devoted to professional activities. The surg...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197610000-00003
更新日期:1976-10-01 00:00:00
abstract:OBJECTIVES:This study investigates the use of data from automated systems within a large managed care plan to create indicators of clinical quality. METHODS:Measures from the first year of Health Plan Employer Data and Information Set, HEDIS 2.0, are used to compare chart review and automated analysis methodologies. T...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199706000-00001
更新日期:1997-06-01 00:00:00
abstract:BACKGROUND:Variance reduction is sometimes considered as a goal of clinical quality improvement. Variance among physicians, hospitals, or health plans has been evaluated as the proportion of total variance (or intraclass correlation, ICC) in a quality measure; low ICCs have been interpreted to indicate low potential fo...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/MLR.0b013e3181c15a6e
更新日期:2010-02-01 00:00:00
abstract:OBJECTIVE:We sought to quantify Veterans Health Administration (VA) patients' utilization of coronary revascularization in the private sector and to assess the potential impact of directing this care to high-performance hospitals. METHODS:Using VA and New York State administrative and clinical databases, we conducted ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000215888.20004.5e
更新日期:2006-06-01 00:00:00
abstract:BACKGROUND:Measures for pay-for-performance and public reporting programs may be based on clinical practice guidelines. The impact of guideline changes over time-and whether evolving clinical evidence can render measures based on prior guidelines misleading-is not known. OBJECTIVE:To assess the impact of using differe...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/MLR.0b013e3181e35b3a
更新日期:2010-08-01 00:00:00
abstract::In comparison to the living conditions that existed before 1949, the People's Republic of China (PRC) represents a remarkable story of achievement. Western knowledge about the PRC has recently increased by leaps and bounds as detente with the United States has allowed many Americans to witness the "awakening of the dr...
journal_title:Medical care
pub_type: 杂志文章
doi:
更新日期:1978-07-01 00:00:00
abstract:BACKGROUND:Healthcare accrediting organizations and insurers increasingly require reporting of clinical data, and cancer treatment is one area of enhanced scrutiny. OBJECTIVES:To compare rates of received versus reported adjuvant breast cancer treatments, and to assess barriers to measuring and reporting treatments to...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182422f7b
更新日期:2013-06-01 00:00:00
abstract::Although there are large-scale forces that influence the economic behavior of the health care delivery system, it is the physician who has primary authority to make decisions about the use of resources. Consequently, when considering alternative options for controlling rising health care expenditures, it is useful to ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198308000-00003
更新日期:1983-08-01 00:00:00
abstract:BACKGROUND:Little is known about the time health professionals spend with inpatients that are close to the end of life. SUBJECTS AND METHODS:We asked day-shift nurses to use a standardized log sheet to record how much time they spent in various categories of activity for 146 seriously ill medical inpatients with poor ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000053226.38288.18
更新日期:2003-04-01 00:00:00
abstract:BACKGROUND:A need exists for adapting existing perioperative risk stratification methods such as the Charlson Comorbidity Index (CCI) for application with hospital administrative data in noncardiac surgery populations. OBJECTIVE:Develop and validate outcome-specific CCIs for predicting inpatient mortality, and cardiac...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000592
更新日期:2016-12-01 00:00:00
abstract::Even with the passage of state safety belt laws, primary care physicians can contribute to their patients' safety by brief interventions. The present study explores the prevalence of such action with adult patients and tests the power of constructs taken from social learning theory to explain physicians' behavior. The...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198804000-00006
更新日期:1988-04-01 00:00:00
abstract::The authors compared the continuity of care that family physicians, general internists, and medical subspecialists provided to their adult primary care patients. The 40 study physicians came from large, private multispecialty practices in the San Francisco Bay Area. The three physician types did not differ significant...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198501000-00007
更新日期:1985-01-01 00:00:00
abstract:BACKGROUND:The number of older patients enrolling in health maintenance organizations (HMOs) is increasing. Concerns have been raised that older patients may be targeted by HMOs for more stringent cost-containment mechanisms, including reduced access to expensive specialty care. OBJECTIVES:We investigated the relation...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199912000-00002
更新日期:1999-12-01 00:00:00
abstract::The burn problem in the United States, as reflected in published data, is serious. More than 2,000,000 people are injured in burn accidents each year; 70,000 are hospitalized, involving approximately 9,000,000 disability days; and an estimated 9,000 die from their injuries. In 1964, the National Burn Information Excha...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198002000-00006
更新日期:1980-02-01 00:00:00
abstract:BACKGROUND:Performance measures often fail to account for legitimate reasons why patients do not achieve recommended treatment targets. METHODS:We tested a novel performance measurement system for blood pressure (BP) control that was designed to mimic clinical reasoning. This clinically guided approach focuses on (1) ...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/MLR.0b013e318245a147
更新日期:2012-05-01 00:00:00
abstract::Satisfaction with health services is an aspect of quality of care that is of special importance for captive clients like low-income clinic users. Several methodologies have been reported, but validation has been difficult. This study compares two older scaling techniques with a new, nonmetric method to detect underlyi...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197803000-00003
更新日期:1978-03-01 00:00:00