Effects of primary health care reform on the prescription of antibiotics: A longitudinal study in a Spanish county

Abstract

When Spain launched the reform of its primary care system in 1984, it was expected that it would improve the prescription of medicines. The primary aims of the present study were to assess differences in the prescription of antibiotics between primary health centres operating in a reformed network (RN) and a non-reformed network (NRN) and to estimate the degree of variability in prescription patterns within each network. The prescription of all groups of drugs containing antibiotics by primary care physicians In the county of Osona (Catalonia, Spain) during 1987–1991 was analysed. Prescription was measured both through the number of packages and cost. Prescription at the beginning of the period was lower in the RN than in the NRN. There was a decline in the total number of antibiotics prescribed during the study period in both networks. The decrease in the RN (-56.6%) was greater than in the NRN (-32.5%), and it was more marked for antibiotics in combination with other drugs than for general anti-infectives for systemic use. The decrease in costs was smaller (-45% in RN and -13% in NRN). During the study period the coefficients of variation increased for all indicators in the 2 networks, but changes were greater in the RN. Longitudinal designs are preferable to cross-sectional approaches when assessing the effects of changes in the organization of health care upon drug prescription.