Visados de inspección: ¿garantía del uso adecuado de los medicamentos o medida de control del gasto?

Abstract

Objective. To assess the views of primary care physicians (PCPs) in Spain regarding the purpose of inspection validation of prescriptions (IVP) and its impact on prescription and patients, as well as doctors' acceptance of this measure. Design. Cross-sectional study through a telephone survey. Setting. Primary care centres. Participants. PCPs prescribing oral diabetes drugs requiring IVP, or who were familiar with IVP. Methods. Telephone survey conducted in October-November, 2003, of 1471 PCPs. Sample size was calculated to ensure accuracy to 10% in each autonomous region. Results. 91.9% of the 1600 PCPs contacted who agreed to participate in the study met the inclusion criteria. On average, they prescribed 30.6 drugs requiring IVP per month (95% CI, 28.0-33.2), requiring an additional 4.6 minutes per prescription (95% CI, 4.4-4.8). 64.7% of PCPs increased their clinical work-time for this reason. 71.3% of PCPs (95% CI, 69.0-73.6) considered IVP an obstacle when prescribing a drug that requires it and 44.5% (95% CI, 42.0-47.0) believed that the IVP puts patients' right to receive the appropriate treatment at risk. PCPs considered that inspectors refuse authorisation of their prescriptions requiring IVP for administrative (43.3%), economic (36.5%), or clinical (13.2%) reasons. 87.1% of PCPs stated that medical prescription is a sufficient control system and that IVP is not necessary for medicines for diseases managed in primary care such as Type-2 DM. 76.2% believed that the health authorities imposed the IVP requirement for some oral diabetes drugs in order to control expenditure on drugs, and 75.4% supported its withdrawal. Conclusion. According to PCPs, the objective of the IVP is mainly economic and may affect negatively their clinical practice and patients. Therefore, in general, they do not support it, at least for drugs for diseases mainly managed in primary care.