Implementing a local prescribing policy

1990 ◽  
Vol 28 (24) ◽  
pp. 93-95 ◽  
Keyword(s):  
General Practice ◽  
Health Service ◽  
Family Health ◽  
District Health ◽  
Health Authorities ◽  
Quality Of Prescribing

We concluded recently that local prescribing formularies are worth the time and money they take to produce.1 If they are well used in hospitals and in general practice they improve the quality of prescribing and reduce overall costs. The NHS Review Working for Patients, published since our report, encourages family health service authorities (FHSA) and district health authorities to develop joint formularies to facilitate continuity of treatment between hospital and community.2 This article reviews how a local prescribing policy can be developed used and monitored.

The quality of prescribing in general practice in Kerman, Iran

2005 ◽  
Vol 18 (5) ◽  
pp. 353-360 ◽  
Author(s):  
Gholamreza‐Sepehri ◽  
Manzumeh‐Shamsi Meimandi
Keyword(s):  
General Practice ◽  
Quality Of Prescribing

scholarly journals Advice to purchasing authorities

1993 ◽  
Vol 17 (3) ◽  
pp. 164-165
Author(s):  
Peter Urwin
Keyword(s):  
Health Care ◽  
National Health Service ◽  
Health Service ◽  
Health Care Needs ◽  
Care Needs ◽  
District Health ◽  
Professional Advice ◽  
Health Authorities ◽  
Provision Of Services ◽  
Second Year

We are now well into the second year of the separation of purchaser and provider functions in the National Health Service. District health authorities as purchasers of services are required to assess the health care needs of their population (NHS Management Executive, 1991a) and seek professional advice regarding both the need for, and the provision of, services. The NHS Management Executive acknowledges that local clinicians in provider units will continue to make a major contribution to this advice (NHS Management Executive, 1991b).

scholarly journals Sub-optimal prescribing in an adult community mental health service: prevalence and determinants

2003 ◽  
Vol 27 (07) ◽  
pp. 266-270 ◽  
Author(s):  
David Meagher ◽  
Maria Moran
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Quality Score ◽  
Evidence Based ◽  
Community Mental Health Service ◽  
Prescribing Practice ◽  
Quality Of Prescribing ◽  
Evidence Based Guidelines

Aims and Method To compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis. Results Five-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75 ± 0.99. Maintenance benzodiazepine/ hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P < 0.01) and in older patients (P < 0.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P < 0.001). Clinical Implications Prescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.

scholarly journals Sub-optimal prescribing in an adult community mental health service: prevalence and determinants

2003 ◽  
Vol 27 (7) ◽  
pp. 266-270 ◽  
Author(s):  
David Meagher ◽  
Maria Moran
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Quality Score ◽  
Evidence Based ◽  
Community Mental Health Service ◽  
Prescribing Practice ◽  
Quality Of Prescribing ◽  
Evidence Based Guidelines

Aims and MethodTo compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis.ResultsFive-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75 ± 0.99. Maintenance benzodiazepine/ hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P < 0.01) and in older patients (P < 0.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P < 0.001).Clinical ImplicationsPrescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.

scholarly journals FAKTOR-FAKTOR YANG MEMPENGARUHI PENINGKATAN DERAJAT KESEHATAN KELUARGA MELALUI POSDAYA DI KOTA BEKASI

2018 ◽  
Vol 1 (02) ◽  
Author(s):  
Sri Budianti
Keyword(s):  
Health Service ◽  
Service Quality ◽  
Human Resources ◽  
Policy Implementation ◽  
Community Participation ◽  
Family Health ◽  
Factors Affecting ◽  
Family Empowerment ◽  
Health Service Quality

FAKTOR-FAKTOR YANG MEMPENGARUHI PENINGKATAN DERAJAT KESEHATAN KELUARGA MELALUI POSDAYA DI KOTA BEKASI Abstrak Studi ini untuk mengetahui seberapa jauh implementasi kebijakan, kepemimpinan, implementasi sumber daya manusia (SDM) dan partisipasi masyarakat dalam mempengaruhi kualitas pelayanan kesehatan yang dilaksanakan oleh pos pemberdayaan keluarga (posdaya). Metode yang digunakan adalah analisis statistik deskriptif dan analisis inferensial melalui kuesioner. Survei mencakup 240 responden dari 20 posdaya. Hasil survei menunjukkan bahwa terdapat pengaruh signifikan dari implementasi kebijakan, kepemimpinan, implementasi SDM dan partisipasi masyarakat terhadap kualitas pelayanan kesehatan, baik secara parsial maupun keseluruhan. Partisipasi masyarakat merupakan faktor pendukung utama yang mempengaruhi pelayanan kesehatan diikuti dengan implementasi SDM, implementasi kebijakan dan kepemimpinan sebagai faktor pendukung terakhir. Dalam rangka peningkatan kualitas pelayanan kesehatan secara lebih efektif, perlu peningkatan kapasitas posdaya dan kompetensi serta pengetahuan terutama untuk kader-kader kesehatan dalam program preventif dan promotif bidang kesehatan, antara lain melalui pelatihan dan bimbingan serta dilakukan pengawasan dan evaluasi secara berkala. Kata kunci: pemberdayaan keluarga, kualitas pelayanan kesehatan, partisipasi masyarakat Factors Affecting the Family Health Degree Improvement Through Posdaya in Bekasi Municipality Abstract The survey was conducted to search how far the policy implementation, the leadership, the human resources implementation and community participation influence the quality of health services done by family empowerment program (posdaya). The sample taken from with 240 respondents selected from 20 posdaya. The method used is descriptive statistical analysis and inferential analysis through questionnaires. The survey proved that there is significant influence of the policy implementation, leadership, the human resources implementation, and the community participation against the health service quality either partially or simultaneously. The community participation is a primary supporting factor that influence the quality of health service followed by the implementation of human resources, the policy implementation, and leadership is the last supporting factor. Thus, posdaya, in improving the health service quality to be more effective, should be up graded and raised the competence and knowledge primarily of the health cares in health preventive and promotive program through training, assistance, as well as monitoring, and periodic evaluation. Keywords: family empowerment, quality health service, community participation

How drugs get to market

1990 ◽  
Vol 28 (26) ◽  
pp. 101-104
Keyword(s):  
General Practice ◽  
Health Service ◽  
European Community ◽  
New Products ◽  
Family Health ◽  
Cost Effective ◽  
Present System ◽  
Detailed Review ◽  
New Guidelines ◽  
The Many

The Department of Health’s new guidelines for its ‘indicative prescribing’ scheme in general practice1 mean that Family Health Service Authorities (FHSAs) will be encouraging GPs to achieve rational, cost-effective prescribing, especially where prescribing costs have been well above, or well below, average. GPs will get help from various sources including, Prescribing Analyses and Costs (PACT) data and from the new local prescribing advisers, but they will still have to evaluate the many new medicines each year. Because of this, we shall next year publish short notes on new products soon after they are introduced. We will aim to assess evidence cited at their launch, without precluding more detailed review later. It is thus timely to outline the key stages by which a new medicine reaches the market. This article discusses the strengths and some weaknesses of the present system, and the changes foreseen as European Community rules begin to work.

General Practice Manpower and Health Service Reorganization

1974 ◽  
Vol 3 (3) ◽  
pp. 235-250 ◽  
Author(s):  
J. R. Butler ◽  
R. Knight
Keyword(s):  
General Practice ◽  
National Health Service ◽  
Health Service ◽  
Final Section ◽  
Medical Practices ◽  
The United Kingdom ◽  
Health Authorities ◽  
Service Reorganisation ◽  
Administrative Framework ◽  
Medical Manpower

ABSTRACTThe article deals with the geographical imbalance of medical manpower in general practice; it describes corrective policies employed in the NHS, some major administrative problems stemming from those policies, and the prospects under reorganization.First, the problem is seen within the context of inequalities in the distribution of other health and welfare services in the United Kingdom and of medical manpower in other countries. The second section summarizes the three major strategies employed since 1948: the Medical Practices Committee, the Initial Practice Allowances and the Designated Area Allowance. Problems arising from these policies include the fragmentation of responsibility, the lack of agreed objectives and the haphazard nature of the geographical units within which restrictions and incentives operate. The final section deals with the opportunity, presented by the 1973 National Health Service Reorganisation Act, to restructure these unsatisfactory features of the administrative framework. It is feared that the impetus for change is in danger of being lost, and that the establishment of the new health authorities alongside the old, largely unaltered machinery will merely add to the fragmentation of responsibility, thus exacerbating the imbalance of resources.

scholarly journals Medication Prescribing Quality in Australian Primary Care Patients with Chronic Kidney Disease

2020 ◽  
Vol 9 (3) ◽  
pp. 783 ◽  
Author(s):  
Woldesellassie M. Bezabhe ◽  
Alex Kitsos ◽  
Timothy Saunder ◽  
Gregory M. Peterson ◽  
Luke R. Bereznicki ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
General Practice ◽  
Inappropriate Prescribing ◽  
Potentially Inappropriate Prescribing ◽  
Appropriate Prescribing ◽  
Quality Of Prescribing ◽  
Nationally Representative ◽  
Ras Inhibitors

Background: Australian patients with chronic kidney disease (CKD) are routinely managed in general practices with multiple medications. However, no nationally representative study has evaluated the quality of prescribing in these patients. The objective of this study was to examine the quality of prescribing in patients with CKD using nationally representative primary care data obtained from the NPS MedicineWise’s dataset, MedicineInsight. Methods: A cross-sectional analysis of general practice data for patients aged 18 years or older with CKD was performed from 1 February 2016 to 1 June 2016. The study examined the proportion of patients with CKD who met a set of 16 published indicators in two categories: (1) potentially appropriate prescribing of antihypertensives, renin-angiotensin system (RAS) inhibitors, phosphate binders, and statins; and (2) potentially inappropriate prescribing of nephrotoxic medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), at least two RAS inhibitors, triple therapy (an NSAID, a RAS inhibitor and a diuretic), high-dose digoxin, and metformin. The proportion of patients meeting each quality indicator was stratified using clinical and demographic characteristics. Results: A total of 44,259 patients (24,165 (54.6%) female; 25,562 (57.8%) estimated glomerular filtration (eGFR) 45–59 mL/1.73 m2) with CKD stages 3–5 were included. Nearly one-third of patients had diabetes and were more likely to have their blood pressure and albumin-to-creatinine ratio monitored than those without diabetes. Potentially appropriate prescribing of antihypertensives was achieved in 79.9% of hypertensive patients with CKD stages 4–5. The prescribing indicators for RAS inhibitors in patients with microalbuminuria and diabetes and in patients with macroalbuminuria were achieved in 69.9% and 62.3% of patients, respectively. Only 40.8% of patients with CKD and aged between 50 and 65 years were prescribed statin therapy. The prescribing of a RAS inhibitor plus a diuretic was less commonly achieved, with the indicator met in 20.6% for patients with microalbuminuria and diabetes and 20.4% for patients with macroalbuminuria. Potentially inappropriate prescribing of NSAIDs, metformin, and at least two RAS inhibitors were apparent in 14.3%, 14.1%, and 7.6%, respectively. Potentially inappropriate prescribing tended to be more likely in patients aged ≥65 years, living in regional or remote areas, or with socio-economic indexes for areas (SEIFA) score ≤ 3. Conclusions: We identified areas for possible improvement in the prescribing of RAS inhibitors and statins, as well as deprescribing of NSAIDs and metformin in Australian general practice patients with CKD.

scholarly journals Profiling bone and joint problems and health service use in an Australian regional population: The Port Lincoln Health Study

2013 ◽  
Vol 37 (4) ◽  
pp. 504 ◽  
Author(s):  
Clarabelle Pham ◽  
Tiffany K. Gill ◽  
Elizabeth Hoon ◽  
Muhammad Aziz Rahman ◽  
Deirdre Whitford ◽  
...  
Keyword(s):  
Quality Of Life ◽  
General Practice ◽  
Health Service ◽  
Health Professionals ◽  
Allied Health ◽  
Computer Assisted ◽  
Care Pathways ◽  
Allied Health Professionals ◽  
Regional Population

Objectives To describe the burden of bone and joint problems (BJP) in a defined regional population, and to identify characteristics and service-usage patterns. Methods In 2010, a health census of adults aged ≥15 years was conducted in Port Lincoln, South Australia. A follow-up computer-assisted telephone interview provided more specific information about those with BJP. Results Overall, 3350 people (42%) reported current BJP. General practitioners (GP) were the most commonly used provider (85%). People with BJP were also 85% more likely to visit chiropractors, twice as likely to visit physiotherapists and 34% more likely to visit Accident and Emergency or GP out of hours (compared with the rest of the population). Among the phenotypes, those with BJP with co-morbidities were more likely to visit GP, had a significantly higher mean pain score and higher levels of depression or anxiety compared with those with BJP only. Those with BJP only were more likely to visit physiotherapists. Conclusions GP were significant providers for those with co-morbidities, the group who also reported higher levels of pain and mental distress. GP have a central role in effectively managing this phenotype within the BJP population including linking allied health professionals with general practice to manage BJP more efficiently. What is known about the topic? As a highly prevalent group of conditions that are likely to impact on health-related quality of life and are a common cause of severe long-term disability, musculoskeletal conditions place a significant burden on individuals and the health system. However, far less is known about access and usage of musculoskeletal-related health services and programs in Australia. What does this paper add? As a result of analysing the characteristics of the overall BJP population, as well as phenotypes within it, a greater understanding of patterns of health service interactions, care pathways and opportunities for targeted improvements in delivery of care may be identified. The results emphasise that participants with BJP utilised the services of a narrow range of providers, which may have workforce implications for these sectors. The funding models for physiotherapists and chiropractors in Australia involve a mix of private and fees for service, which limits access to those who have private health insurance or can pay directly for these services. What are the implications for practitioners? These analyses indicate the importance of linking allied health professionals with general practice to manage BJP more efficiently. Alternative and appropriate care pathways need to be more strongly developed and identified for effective management of these conditions rather than relying on a traditional range of practitioners. Alternatively, greater ease of access to allied health practitioners may enable more effective treatment and improved quality of life for those with BJP. There is an urgent need to develop an effective population-based model of integrated care for BJP within regional Australia.

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