Quality control of antimicrobial usage in Reykjavik Hospital in 1994 - 1998: economic impact

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenAims: To investigate the effect of guidelines and supervision of the prescription of antimicrobial agents at Reykjavik Hospital on the cost and the amount used of these agents. Material and methods: The investigation was conducted from 1994 to 1997. Guidelines were issued for the prescription of antimicrobial agents in empirical treatment and for prophylactics in surgery. The availability of these agents was reduced and the physicians had to order these drugs by filling out a special application form. These forms were later on used for the supervision by a pharmacist and an infectious disease physician of the use of antmicrobial agents and to monitor any change in the prescription of the agents. If needed the supervisors gave advice to the clinicians responsible for the patients care. The supervision took place at eight of the wards of the hospital and started at different times during May 1995 to March 1996. Results: The cost of the usage of antimicrobial agents was reduced after the introduction of the supervision. However, as time passed from the implementation of the supervision the cost tended to increase again. The greatest cost reduction was achieved at the departments of surgery or 8.5 million Icelandic crowns. At the departments of medicine the cost reduction was 2.3 million crowns. By correcting for the cost of supervisory staff the real cost decrease was approximately 6 million crowns. The total amount of prescribed antimicrobial agents measured by the Standardised Daily Dosage was reduced in all the concerned wards by 3-14%. Conclusions: The real cost decreases after the implementation of supervision of the prescription of antimicrobial agents was approximately six million Icelandic crowns during 1994 to 1997. Also, the proportion of antimicrobial agents in the total cost of drugs was reduced after the supervision started in spite of increasing mean cost per Standardised Daily Dosage increased at the departments during the study period. The goal of reducing the amount of antimicrobial agents prescribed was also achieved.Markmið: Að kanna áhrif leiðbeininga og eftirlits með gjöf sýklalyfja á Sjúkrahúsi Reykjavíkur á kostnað og magn gefinna sýklalyfja. Með markvissri notkun sýklalyfja er stefnt að því að bæta meðferð sjúklinga, koma í veg fyrir ónauðsynlega sýklalyfjameðferð, fækka legudögum, draga úr umhverfisspjöllum og óþarfa kostnaði við lækningar

Factors affecting general practitioners’ choice of drug therapy: A study in primary healthcare in Iceland

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadINNGANGUR Markmið rannsóknarinnar var að kanna ýmis atriði sem geta haft áhrif á ákvarðanir lækna í heilsugæslu á Íslandi um lyfjameðferð. Jafnframt hvaða atriði kynnu að vera hindrun við ákvarðanatöku. Að lokum að greina hvaða þættir gætu frekar auðveldað ákvarðanatöku. EFNIVIÐUR OG AÐFERÐIR Sendur var rafrænn spurningalisti með tölvupósti til allra starfandi lækna í heilsugæslu á Íslandi. Spurningalistinn var samsettur úr lokuðum spurningum, opnum textaboxum og röðunarspurningum. Excel var notað við greiningu gagnanna. NIÐURSTÖÐUR Alls svöruðu 93 læknar spurningalistanum og var svarhlutfallið 40,7%. Niðurstöðurnar sýna að læknar telja að klínískar leiðbeiningar, upplýsingar í sérlyfjaskrá og eigin reynsla séu mikilvægastar við val á lyfjameðferð. Þá eru læknar mjög sammála um að skortur á milliverkanaforriti sem tengist sjúkraskrá sjúklings sé hamlandi þáttur við ákvarðanatöku. Þau atriði sem mikilvægast væri að laga til að styðja við ákvarðanir lækna eru innlendir lyfjalistar og milliverkanaforrit sem tengist sjúkraskrá sjúklings. ÁLYKTUN Niðurstöður benda á þætti sem gagnast læknum í heilsugæslu við ákvörðun um lyfjaval, svo sem lyfjalista, milliverkanaforrit, aðgengilegar upplýsingar um lyfjameðferð sjúklinga, mismunandi tímalengd viðtala, gagnreyndar upplýsingar um ný lyf, aðkomu klínískra lyfjafræðinga að starfi heilsugæslu.Introduction: This study aimed to analyse several factors that influence the decision-making of primary care physicians in Iceland in their choice of drug therapy for their patients. Also, to find which factors can act as a hindrance in making the best choices. Finally, to analyse which elements could be most important in facilitating decisions. Material and methods: A questionnaire was sent by e-mail to physicians working in primary care in Iceland. The questionnaire comprised closed questions, open text boxes, and ranking questions. The data was processed and analysed using Microsoft Excel. Results: The total number of primary care physicians who responded to the questionnaire was 93, a response rate of 40.7% of all the primary care physicians. The results reveal that physicians working in primary care consider clinical guidelines, the Icelandic National Formulary, and personal experience to be the most important factors when choosing a medication. Primary care physicians strongly agree that the lack of drug interaction software connected to medical records is a shortcoming. The most important factors that need improvement to facilitate primary care physicians' decision-making are drug formularies and interaction software. Conclusion: The results suggest some factors that support physicians in primary care in making decisions when choosing drug therapy, such as a drug formulary, drug interaction software, information about patients’ drug therapy, variable length in face-to-face consultations, evidence based information on new drugs, and counselling provided by clinical pharmacists

Encouraging rational antibiotic prescribing behaviour in primary care–prescribing practice among children aged 0–4 years 2016–2018 : an observational study

Publisher Copyright: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.OBJECTIVE: To study antibiotic prescriptions among 0- to 4-year-old children before and after implementing a quality project on prudent prescribing of antibiotics in primary healthcare in the capital region of Iceland. DESIGN: An observational, descriptive, retrospective study using quantitative methodology. SETTING: Primary healthcare in the Reykjavik area with a total population of approximately 220,000. SUBJECTS: A total of 6420 children 0-4 years of age presenting at the primary healthcare centres in the metropolitan area over three years from 2016 to 2018. MAIN OUTCOME MEASURES: Reduction of antibiotic prescriptions and change in antibiotic profile. Data on antibiotic prescriptions for children 0-4 years of age was obtained from the medical records. Out-of-hours prescriptions were not included in the database. RESULTS: The number of prescriptions during the study period ranged from 263.6 to 289.6 prescriptions/1000 inhabitants/year. A reduction of 9% in the total number of prescriptions between 2017-2018 was observed. More than half of all prescriptions were for otitis media, followed by pneumonia and skin infections. Amoxicillin accounted for over half of all prescriptions, increasing between 2016 and 2018 by 51.3%. During this period, the prescribing of co-amoxiclav and macrolides decreased by 52.3% and 40.7%, respectively. These changes were significant in all cases, p  < 0.0001. CONCLUSION: The results show an overall decrease in antibiotic prescribing concurrent with a change in the choice of antibiotics prescribed and in line with the recommendations presented in the prescribing guidelines implemented by the Primary Healthcare of the Capital Area, and consistent with the project's goals.Key pointsA substantial proportion of antibiotic prescribing can be considered inappropriate and the antibiotic prescription rate is highest in Iceland of the Nordic countries.After implementing guidance on the treatment of common infections together with feedback on antibiotic prescribing, a decrease in the total number of prescriptions accompanied by a shift in the antibiotic profile was observed.Peer reviewe