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34 Médecine à l’acte/médecine au forfait – ANNEXES KCE Reports 85 S Patients with asthma, if on medication, should have their normal peak flow measured on at least one occasion (2,3) Patients with asthma, if on medication, should have their predicted peak flow calculated on at least one occasion (2,3) Patients presenting with asthma in the last 5 years but not on current medication should have their normal peak flow measured on at least one occasion (2,3) PEFR recorded (7) There should be at least one peak flow reading for all patients who can use a peak flow meter (9) There should be a record of peak flow when well, or best or predicted peak flow (9) Past 5 years record of normal or predicted peak flow or record of difficulty using a peak flow meter (12,16) The percentage of patients age ≥ 8 years diagnosed as having asthma from 1 april 2003 where the diagnosis has been confirmed by spirometry or peak flow measurements (36) Short-acting β2 agonists should only be prescribed on an ‘as required’ basis (2,3) Patients consulting with an acute exacerbation of asthma should have a Peak Expiratory Flow taken and this should be compared to their normal or predicted PEF (2,3) Patients with an exacerbation should be treated with oral corticosteroids by the GP, unless contraindicated or intolerant, if their PEF is < 50% of normal / predicted unless they are admitted to hospital (2,3) Management of acute attacks: nebulised bronchodilatators, systemic steroids (7) Record of degree of asthma control at every visit where asthma is the presenting complaint (1) The record show that patients who require 3 or more doses of short acting inhaled β-agonists daily have also been offered an inhaled anti-inflammatory drug (9) The record show that in patients with exercise induced bronchospasm, short acting bronchodilatators are prescribed for use before exercise (9) Percentage patiënten tussen de 4 en 12 jaar waarbij astma is gedetecteerd in de huisartspraktijk (26) Patients on current medication or presenting with asthma should have their inhaler technique checked at least once every five years (2,3) (Asthma) Over previous year: inhaler technique checked (target standards = 100%) (8) Past 5 years, record of inhaler technique (for asthmatic patients) (16) The record show that if maintenance treatment is to be increased, inhaler technique has been checked, unless there is a prior record of satisfactory inhaler technique (9) The percentage of patients with COPD receiving inhaled treatment in whom there is a record that inhaler technique has been checked in the preceding 2 years (36) Nécessitent des dosages :
KCE Reports 85 S Médecine à l’acte/médecine au forfait – ANNEXES 35 Individualized prescribing data: low corticosteroids: proportion of the GP’s patients using on average per day > 0,5 DDD inhaled bronchodilatators and ≤ 0,5 DDD inhaled cortisteroïds of all the GP’s patients receiving a combination of inhaled bronchodilatators and corticosteroids (34) Situation marginale: Treatment in exacerbation of asthma: treatment with intravenous β agonists or intravenous aminophylline is inappropriate unless there is cotreatment with an inhaled β agonists (9) Patients with asthma should not have been prescribed a beta-blocker unless there is justification for doing so (2,3) USAGE DES ANTIBIOTIQUES Tableau 8: Indicateurs issus de la littérature internationale Indicator Cf Mesurable a priori Measure to ask Comment 1. Ratio : Peadiatric amoxycillin + 11 OUI Number of clavulanate /(to) amoxicillin prescriptions of paediatric amoxycillinclavulanate / amoxycillin 2. Low rate of prescribing of amoxycillin + clavulanic acid compared with oral amoxicillin 3. Ratio : penicillins / (to) cephalosporins 4. Ratio of Nb of items for 4quinolones to Nb of items for all antibiotics 5. Percentage of items for 4quinolones to all antibiotic item in the past year (lower is better) 6. Low rate of prescribing of quinolones antibiotics as a percentage of all antibiotics 7. Ratio of Nb of items for coamoxiclav or 4-quinolones to Nb of items for all antibiotics 8. Oral tetracycline should not be prescribed for adolescents under 12 year of age 9. Aantal voorschriften antibiotica per 1000 ingeschreven patiënten, per jaar 19 OUI Number of prescriptions of Amoxycillin – clavulanate / amoxicillin 11 OUI Number of prescriptions of penicillins / cephalosporins 17 18 Opinion divided on this indicator 19 Opinion of general practitioners about this indicator divided 17 OUI Total number of 4quinolones / all antibiotics Total number of coamoxyclav / all antibiotics 2 OUI Number of patients < 12 years with prescriptions of tetracycline 26 OUI Total number of prescriptions of antibiotics for all the patients of the practice during one year Tableau 9: Indicateurs du Feedback antibiotiques belge - taux à comparer avec taux des autres pratiques - cfr feedback Indicateur Cfr Mesurable Mesure à demander Commentaire
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KCE reports 1. Efficacité et renta
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74. Oxygénothérapie Hyperbare: Ra
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