Originales
Utilización de coxibs: una estrategia de intervención en la atención primaria
Prescription of cyclooxygenase-2 inhibitors: an intervention strategy in primary care
Isabel Rosicha, Maria Solera,
, Rosa Tomása, Dolors Crusatb
Autor para correspondencia
msoler.cp.ics@gencat.net
Correspondencia: María Soler Cera. Servei d’Atenció Primària Alt Penedès Garraf. Manuel Marqués, s/n. 08800 Vilanova i la Geltrú. Barcelona. España.
Correspondencia: María Soler Cera. Servei d’Atenció Primària Alt Penedès Garraf. Manuel Marqués, s/n. 08800 Vilanova i la Geltrú. Barcelona. España.
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1001
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"es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213911105713558?idApp=WGSE" "url" => "/02139111/0000001900000003/v2_201302051756/S0213911105713558/v2_201302051756/es/main.assets" ] "es" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Originales</span>" "titulo" => "Utilización de coxibs: una estrategia de intervención en la atención primaria" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "229" "paginaFinal" => "234" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Isabel Rosich, Maria Soler, Rosa Tomás, Dolors Crusat" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Isabel" "apellidos" => "Rosich" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 1 => array:4 [ "nombre" => "Maria" "apellidos" => "Soler" "email" => array:1 [ 0 => "msoler.cp.ics@gencat.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 2 => array:3 [ "nombre" => "Rosa" "apellidos" => "Tomás" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "Dolors" "apellidos" => "Crusat" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servei d’Atenció Primària Alt Penedès Garraf. Institut Català de la Salut. Vilanova i la Geltrú. Barcelona. España" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servei d’Atenció Primària. Laboratorios. Institut Català de la Salut. Vilanova i la Geltrú. Barcelona. España" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: María Soler Cera. Servei d’Atenció Primària Alt Penedès Garraf. Manuel Marqués, s/n. 08800 Vilanova i la Geltrú. Barcelona. España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Prescription of cyclooxygenase-2 inhibitors: an intervention strategy in primary care" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-04-13" "fechaAceptado" => "2005-03-03" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec16898" "palabras" => array:4 [ 0 => "Coxibs" 1 => "Intervención" 2 => "Alertas de seguridad" 3 => "Atención primaria" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec16899" "palabras" => array:4 [ 0 => "COXIBs" 1 => "Intervention" 2 => "Safety alerts" 3 => "Primary care" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Evaluar una intervención dirigida a mejorar la prescripción de antiinflamatorios no esteroideos (AINE), fundamentalmente del grupo de los inhibidores de la ciclooxigenenasa-2 (coxibs).</p> <span class="elsevierStyleSectionTitle">Sujetos y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Estudio de intervención antes-después individual para médicos altamente prescriptores y grupal para el resto. Los datos sobre prescripción se obtuvieron del aplicativo de farmacia del Institut Català de la Salut. El período preintervención se comparó con el postintervención inmediato (que coincidió con la publicación de una alerta farmacológica sobre los efectos secundarios de los coxibs) y tardío. Se controlaron el gasto de coxibs, la dosis diaria definida (DDD) por 1.000 habitantes/día (DHD), el porcentaje DHD coxibs/total AINE, el porcentaje de AINE recomendados/total AINE, y el coste medio diario de la DDD de AINE.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">La reducción media mensual del gasto en coxibs fue de 19.480 €/mes en el período postintervención inmediato y de 18.555 €/mes en el tardío. La disminución de la DHD de coxibs fue del 35,4% (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), y fue estable en el tiempo. El porcentaje de AINE recomendados/total se incrementó un 14% a corto plazo y un 17% a largo plazo, mientras que el coste medio diario se redujo un 10,1 y 11,2%. La disminución de DHD de coxibs en los médicos entrevistados fue del 39,5% en el período inmediato y del 42,2% en el tardío, frente al 19,4 y al 12,4% en la intervención grupal.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La intervención educativa se asoció con una mejora en la prescripción de AINE, aunque la coincidencia con la alerta de seguridad limita la atribución causal a ésta.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To evaluate an intervention designed to rationalize prescription of nonsteroidal anti-inflammatory drugs (NSAIDs), especially cyclooxygenase-2 inhibitors (COXIBs).</p> <span class="elsevierStyleSectionTitle">Subjects and methods</span><p class="elsevierStyleSimplePara elsevierViewall">We performed a before-after intervention study. Face-to-face educational outreach visits were conducted in general practitioners who were heavy prescribers and group intervention for the remaining. Data on prescribing habits were obtained from the pharmacy database of the Catalan Health Institute. The pre-intervention period (period 1) was compared with the immediate postintervention period (period 2, which coincided with the publication of a safety alert on the adverse effects of COXIBs) and the late postintervention period (period 3). The data monitored were: <span class="elsevierStyleItalic">a)</span> expenditure due to COXIBs; <span class="elsevierStyleItalic">b)</span> consumption in daily defined doses (DDD) per 1,000 habitants/ day (DHD); <span class="elsevierStyleItalic">c)</span> the percentage of COXIBs/total NSAIDs and the percentage of recommended NSAIDs/total NSAIDs, and <span class="elsevierStyleItalic">d)</span> the mean daily cost of DHD of NSAIDs.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The mean monthly reduction in expenditure on COXIBs was 19,480 €/month in period 2 and was 18,555 €/month in period 3. The percentage of reduction in DHD of COXIBs was 35.4% (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), which remained stable throughout the study. The percentage of recommended NSAIDs/total NSAIDs increased 14% in the short term and 17% in the long term while the mean daily cost was reduced by 10.1% and 11.2%. The decrease in DHD of COXIBs in the face-to-face intervention group was 39.5% in period 2 and was 42.2% period 3 compared with 19.4% and 12.4% in the group intervention.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The educational intervention was associated with improvements in prescription of NSAIDs, although some of the improvement was probably due to the safety alert issued during the study period.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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Información del artículo
ISSN: 02139111Idioma original: Español
DOI:10.1157/13075956
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