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Dictionary of Evidence-based Medicine.pdf

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6 <strong>Dictionary</strong> <strong>of</strong> <strong>Evidence</strong>-<strong>based</strong> <strong>Medicine</strong><br />

As treated analysis (see Intention to treat analysis)<br />

ASTRO-PUs<br />

Prescriptions written by general practitioners and dispensed by pharmacists<br />

in England are sent to the Prescription Pricing Authority for pricing<br />

so that reimbursements can be made to the pharmaceutical contractors.<br />

The data held provide information on the number <strong>of</strong> prescriptions dispensed,<br />

the drugs dispensed, the dosage forms and the number <strong>of</strong> units dispensed<br />

but not the diagnosis. Age groupings are made broadly on the basis<br />

<strong>of</strong> prescription exemptions. Those under 16 and pensioners are exempt<br />

from payment. In drug utilization studies, it is useful to make adjustments<br />

to account for covariates which may influence prescribing. The ASTRO-<br />

PUs was a weighting scheme developed to make such adjustments.<br />

Eighteen age-sex groupings and one temporary resident group were<br />

defined in that scheme which has since been further developed<br />

to facilitate comparisons at the therapeutic group level (see STAR-PUs)<br />

(Roberts S, Harris CM (1993) Age, sex and temporary resident originated<br />

prescribing units (ASTRO-PUs): new weightings for analysing prescribing<br />

<strong>of</strong> general practices in England. BMJ. 307: 485-8).<br />

Audit<br />

An audit is an <strong>of</strong>ficial examination, usually <strong>of</strong> accounts, to assess how well<br />

a business or service is functioning. Auditing is now usually thought <strong>of</strong> in<br />

terms <strong>of</strong> a cycle whereby practice is assessed by independent observers<br />

and checked against prospectively set standards. Any deficiency is highlighted<br />

and brought to the attention <strong>of</strong> the appropriate managers so that<br />

appropriate changes can be agreed upon and implemented. Subsequently,<br />

practice is again observed to complete the cycle (Figure 1). High standards<br />

<strong>of</strong> practice can therefore be achieved and maintained through this system<br />

<strong>of</strong> quality assurance.<br />

Audit Commission<br />

The UK Audit Commission was established in 1983 to appoint and<br />

regulate the external auditors <strong>of</strong> local authorities in England and Wales. In<br />

1990, its responsibilities were extended to include the National Health<br />

Service, which provides health care for all UK citizens. Its auditors are<br />

required to examine arrangements made by health authorities for securing<br />

economy, efficiency and effectiveness in areas <strong>of</strong> expenditure for which<br />

they are responsible. One <strong>of</strong> the Commission's most recent reports on the

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