Ávísanir á sýklalyf : könnun á ávísanavenjum heimilislækna á sýklalyf á Suðurnesjum og í Hafnarfirði 1.-15. apríl 1986

Abstract

In this study we analyze the ambulatory use of antibiotics and chemotherapeutics in the districts of Sudurnes and Hafnarfjördur in Iceland. Special attention was focused on prescriptions habits by the individual general practioner (GP), and possible relation to his age or education. All prescriptions during the period from April 1st to 15th 1986 were collected and computerized. Defined daily dose (DDD) was calculated according to the methods described by Nordic Council on Medicines. The total amount of antimicrobial agents prescribed in Sudurnes was 25,0 DDD/1000 inhab/day compared with 23,4 DDD/1000 inhab/day in Hafnarfjördur (p< 0,001, RR 1,16). This is a higher prescriptions rate than reported from other parts of Iceland. Ampicillins were the most commonly prescribed antimicrobial in the district of Sudurnes. This is probably best explained by the prescription habits of two of the GPs. The choice of antibiotics prescribed to patients 15 years and older were quite different among the GPs, one using mainly ampicillins, another used tetracyclins in about 50% of the cases and the third one used mostly penicillins. The study supports the view that explanations for the high use of antimicrobials in Iceland should be sought and analysed at regional levels, especially among the doctors themselves. Study like this is a part of a medical audit and should hopefully stimulate further discussion as to the appropriate changes in pre- and postgraduate education in general practice.

Íslenskir læknar hafa um árabil ávísað hlutfallslega meira af sýklalyfjum (1) en gert er á hinum Norðurlöndunum. Þeir skera sig einnig úr með mikilli notkun breiðvirkra sýklalyfja og þá aðallega úr flokki ampisillína. Ýmsar tilgátur hafa verið settar fram sem skýring á þessu (2, 3) svo sem að: * bakteríusýkingar séu algengari hér á landi en erlendis, * fjöldi ávísana á sýklalyf sé hugsanlega háður menntun læknisins, starfsálagi, starfsaðstöðu, aldri, kennslu í grunnnámi, framhaldsnámi eða endurmenntun, * verðlagning lyfja og hlutur sjúklinga í þeim kostnaði hafi áhrif á neysluna, * þekkingu lækna og kennslu hérlendis á þessu sviði sé ábótavant, * auðvelt sé að ná til læknis. Heimilislæknar ávísa flestum lyfjum utan sjúkrahúsa (4). Erlendis er talið að hlutur þeirra hvað varðar sýklalyfjaávísanir eingöngu sé um 85% (5). Tilgangur þessarar könnunar var að athuga ávísanir á sýklalyf á Suðurnesjum og í Hafnarfirði og ávísanavenjur einstakra heimilislækna á þessu svæði.