Updating and validating quality prescribing indicators for use in Australian general practice
Cuu Phuong Linh Dang A D , Li Shean Toh A B , Nick Cooling C , Shane Jackson A , Colin Curtain A , Angus Thompson A and Gregory Peterson A
+ Author Affiliations
- Author Affiliations
A Division of Pharmacy, School of Medicine, University of Tasmania, Private Bag 26, Hobart, Tas. 7001, Australia.
B Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham NG9 2RD, UK.
C Division of Medicine, School of Medicine, University of Tasmania, Private Bag 34, Hobart, Tas. 7001, Australia.
D Corresponding author. Email: cpldang@utas.edu.au
Australian Journal of Primary Health 26(1) 31-42 https://doi.org/10.1071/PY19060
Submitted: 25 March 2019 Accepted: 18 August 2019 Published: 23 December 2019
Abstract
This study aims to update and validate quality prescribing indicators (QPIs) for Australian general practice. The study comprised two phases: (1) developing preliminary potential QPIs based on the 2006 National Prescribing Service (NPS) MedicineWise indicators, published literature, international indicators and guidelines, and through qualitative focus group discussions; and (2) validating the proposed QPIs through a two-round online survey using the Delphi technique. The Delphi panel included four GPs, four pharmacists and two clinical pharmacologists. The Delphi panel rated the potential QPIs for their validity, importance and feasibility using a 1–10 Likert scale. In round one, all proposed QPIs presented as ‘prescribing rules’ achieved high scores regarding validity, importance and feasibility No rule was eliminated and three new rules were introduced. Rules were reworded into ‘prescribing indicators’ for round two, which resulted in 35 indicators being accepted and two indicators being eliminated. The final QPIs also include seven drug–drug interactions, which received high scores in round one. In conclusion, 42 QPIs were nominated for use in Australian general practice, based on their validity, importance and feasibility. If implemented, these QPIs have the potential to assist in efforts to improve the quality and safety of medicines management.
Additional keywords: drugs, general practice, medication-related problem, prescribing, quality indicator, quality of care.
References
Australian Commission on Safety and Quality in Health Care (ACSQHC), NSW Therapeutic Advisory Group (2014) ‘National Quality Use of Medicines Indicators for Australian Hospitals.’ (ACSQHC: Sydney, NSW, Australia)Avery AJ, Dex GM, Mulvaney C, Serumaga B, Spencer R, Lester HE, Campbell SM (2011) Development of prescribing-safety indicators for GPs using the RAND Appropriateness Method. The British Journal of General Practice 61, e526–e536.
| Development of prescribing-safety indicators for GPs using the RAND Appropriateness Method.Crossref | GoogleScholarGoogle Scholar | 21801572PubMed |
Basger BJ, Chen TF, Moles RJ (2008) Inappropriate medication use and prescribing indicators in elderly Australians: development of a prescribing indicators tool. Drugs & Aging 25, 777–793.
| Inappropriate medication use and prescribing indicators in elderly Australians: development of a prescribing indicators tool.Crossref | GoogleScholarGoogle Scholar |
Basger BJ, Chen TF, Moles RJ (2012) Validation of prescribing appropriateness criteria for older Australians using the RAND/UCLA appropriateness method. BMJ Open 2, e001431
| Validation of prescribing appropriateness criteria for older Australians using the RAND/UCLA appropriateness method.Crossref | GoogleScholarGoogle Scholar | 22983875PubMed |
Beer C, Hyde Z, Almeida OP, Norman P, Hankey GJ, Yeap BB, Flicker L (2011) Quality use of medicines and health outcomes among a cohort of community dwelling older men: an observational study. British Journal of Clinical Pharmacology 71, 592–599.
| Quality use of medicines and health outcomes among a cohort of community dwelling older men: an observational study.Crossref | GoogleScholarGoogle Scholar | 21395652PubMed |
Benson H, Lucas C, Kmet W, Benrimoj SI, Williams K (2018) Pharmacists in general practice: a focus on drug-related problems. International Journal of Clinical Pharmacy 40, 566–572.
| Pharmacists in general practice: a focus on drug-related problems.Crossref | GoogleScholarGoogle Scholar | 29542035PubMed |
Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C (2011) Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One 6, e20476
| Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review.Crossref | GoogleScholarGoogle Scholar | 21694759PubMed |
Britt H, Miller GC, Henderson J, Bayram C, Harrison C, Valenti L, Pan Y, Charles J, Pollack AJ, Wong C, Gordon J (2016) General practice activity in Australia 2015–16. General practice series number 40. (Sydney University Press: Sydney, NSW, Australia) Available at http://hdl.handle.net/2123/15514 [Verified June 2017]
By the American Geriatrics Society Beers Criteria Update Expert Panel (2015) American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society 63, 2227–2246.
| American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults.Crossref | GoogleScholarGoogle Scholar | 26446832PubMed |
Campbell SM, Braspenning J, Hutchinson A, Marshall M (2002) Research methods used in developing and applying quality indicators in primary care. Quality & Safety in Health Care 11, 358–364.
| Research methods used in developing and applying quality indicators in primary care.Crossref | GoogleScholarGoogle Scholar |
Duerden M, Millson D, Avery A, Smart S (2011) ‘The Quality of GP Prescribing.’ (The King’s Fund: London, UK)
Fastbom J, Johnell K (2015) National indicators for quality of drug therapy in older persons: the Swedish experience from the first 10 years. Drugs & Aging 32, 189–199.
| National indicators for quality of drug therapy in older persons: the Swedish experience from the first 10 years.Crossref | GoogleScholarGoogle Scholar |
Gadzhanova S, Roughead EE, Loukas K, Vajda J (2011) Improvement in metformin and insulin utilisation in the Australian veteran population associated with quality use of medicines intervention programs. Pharmacoepidemiology and Drug Safety 20, 359–365.
| Improvement in metformin and insulin utilisation in the Australian veteran population associated with quality use of medicines intervention programs.Crossref | GoogleScholarGoogle Scholar | 21442685PubMed |
Gadzhanova SV, Roughead EE, Bartlett MJ (2013) Improving cardiovascular disease management in Australia: NPS MedicineWise. The Medical Journal of Australia 199, 192–195.
| Improving cardiovascular disease management in Australia: NPS MedicineWise.Crossref | GoogleScholarGoogle Scholar | 23909542PubMed |
Hanlon JT, Schmader KE (2005) Drug-drug interactions in older adults: which ones matter? The American Journal of Geriatric Pharmacotherapy 3, 61–63.
| Drug-drug interactions in older adults: which ones matter?Crossref | GoogleScholarGoogle Scholar | 16129382PubMed |
Harris CM (2018) ‘Prescribing in General Practice.’ (CRC Press: Boca Raton, FL, USA)
Holt S, Schmiedl S, Thürmann PA (2010) Potentially inappropriate medications in the elderly: the PRISCUS list. Deutsches Ärzteblatt International 107, 543–551.
| Potentially inappropriate medications in the elderly: the PRISCUS list.Crossref | GoogleScholarGoogle Scholar | 20827352PubMed |
Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O’Brien MA, Johansen M, Grimshaw J, Oxman AD (2012) Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2012, CD000259
| Audit and feedback: effects on professional practice and healthcare outcomes.Crossref | GoogleScholarGoogle Scholar |
Kaufmann CP, Tremp R, Hersberger KE, Lampert ML (2014) Inappropriate prescribing: a systematic overview of published assessment tools. European Journal of Clinical Pharmacology 70, 1–11.
| Inappropriate prescribing: a systematic overview of published assessment tools.Crossref | GoogleScholarGoogle Scholar | 24019054PubMed |
Keeney S, Hasson F, McKenna H (2011) ‘The Delphi Technique in Nursing and Health Research.’ (Wiley-Blackwell: Oxford, UK)
Kontopantelis E, Springate D, Reeves D, Ashcroft DM, Valderas JM, Doran T (2014) Withdrawing performance indicators: retrospective analysis of general practice performance under UK Quality and Outcomes Framework. BMJ (Clinical Research Ed.) 348, g330
| Withdrawing performance indicators: retrospective analysis of general practice performance under UK Quality and Outcomes Framework.Crossref | GoogleScholarGoogle Scholar |
Kuhn-Thiel AM, Weiß C, Wehling M (2014) Consensus validation of the FORTA (fit for the aged) list: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs & Aging 31, 131–140.
| Consensus validation of the FORTA (fit for the aged) list: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly.Crossref | GoogleScholarGoogle Scholar |
Laroche M-L, Charmes J-P, Merle L (2007) Potentially inappropriate medications in the elderly: a French consensus panel list. European Journal of Clinical Pharmacology 63, 725–731.
| Potentially inappropriate medications in the elderly: a French consensus panel list.Crossref | GoogleScholarGoogle Scholar | 17554532PubMed |
Lindblad CI, Hanlon JT, Gross CR, Sloane RJ, Pieper CF, Hajjar ER, Ruby CM, Schmader KE (2006) Clinically important drug-disease interactions and their prevalence in older adults. Clinical Therapeutics 28, 1133–1143.
| Clinically important drug-disease interactions and their prevalence in older adults.Crossref | GoogleScholarGoogle Scholar | 16982290PubMed |
Maio V, Del Canale S, Abouzaid S (2010) Using explicit criteria to evaluate the quality of prescribing in elderly Italian outpatients: a cohort study. Journal of Clinical Pharmacy and Therapeutics 35, 219–229.
| Using explicit criteria to evaluate the quality of prescribing in elderly Italian outpatients: a cohort study.Crossref | GoogleScholarGoogle Scholar | 20456742PubMed |
Malone DC, Armstrong EP, Abarca J, Grizzle AJ, Hansten PD, Van Bergen RC, Duncan-Edgar BS, Solomon SL, Lipton RB (2004) Identification of serious drug–drug interactions: results of the partnership to prevent drug–drug interactions. Journal of the American Pharmacists Association 44, 142–151.
| Identification of serious drug–drug interactions: results of the partnership to prevent drug–drug interactions.Crossref | GoogleScholarGoogle Scholar | 15098848PubMed |
Mann E, Böhmdorfer B, Frühwald T, Roller-Wirnsberger RE, Dovjak P, Dückelmann-Hofer C, Fischer P, Rabady S, Iglseder B (2012) Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list. Wiener Klinische Wochenschrift 124, 160–169.
| Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list.Crossref | GoogleScholarGoogle Scholar | 22134410PubMed |
Meltzer DO, Chung JW (2014) The population value of quality indicator reporting: a framework for prioritizing health care performance measures. Health Affairs 33, 132–139.
| The population value of quality indicator reporting: a framework for prioritizing health care performance measures.Crossref | GoogleScholarGoogle Scholar | 24395945PubMed |
National Prescribing Service (2006) ‘Indicators of Quality Prescribing in Australian General Practice: A Manual for Users.’ (National Prescribing Service: Sydney, NSW, Australia)
O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P (2015) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age and Ageing 44, 213–218.
| STOPP/START criteria for potentially inappropriate prescribing in older people: version 2.Crossref | GoogleScholarGoogle Scholar | 25324330PubMed |
Parameswaran Nair N, Chalmers L, Bereznicki BJ, Curtain C, Peterson GM, Connolly M, Bereznicki LR (2017) Adverse drug reaction-related hospitalizations in elderly Australians: a prospective cross-sectional study in two Tasmanian hospitals. Drug Safety 40, 597–606.
| Adverse drug reaction-related hospitalizations in elderly Australians: a prospective cross-sectional study in two Tasmanian hospitals.Crossref | GoogleScholarGoogle Scholar | 28382494PubMed |
Price SD, Holman CD, Sanfilippo FM, Emery JD (2014) Are older Western Australians exposed to potentially inappropriate medications according to the Beers Criteria? A 13-year prevalence study. Australasian Journal on Ageing 33, E39–E48.
| Are older Western Australians exposed to potentially inappropriate medications according to the Beers Criteria? A 13-year prevalence study.Crossref | GoogleScholarGoogle Scholar | 24649962PubMed |
Renom-Guiteras A, Meyer G, Thurmann PA (2015) The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries. European Journal of Clinical Pharmacology 71, 861–875.
| The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries.Crossref | GoogleScholarGoogle Scholar | 25967540PubMed |
Rognstad S, Brekke M, Fetveit A, Spigset O, Wyller TB, Straand J (2009) The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients: a modified Delphi study. Scandinavian Journal of Primary Health Care 27, 153–159.
| The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients: a modified Delphi study.Crossref | GoogleScholarGoogle Scholar | 19462339PubMed |
Roughead EE, Semple SJ (2009) Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002–2008. Australia and New Zealand Health Policy 6, 18
| Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002–2008.Crossref | GoogleScholarGoogle Scholar | 19671158PubMed |
Shrank WH, Asch SM, Adams J, Setodji C, Kerr EA, Keesey J, Malik S, McGlynn EA (2006) The quality of pharmacologic care for adults in the United States. Medical Care 44, 936–945.
| The quality of pharmacologic care for adults in the United States.Crossref | GoogleScholarGoogle Scholar | 17001265PubMed |
Spencer R, Bell B, Avery AJ, Gookey G, Campbell SM (2014) Identification of an updated set of prescribing-safety indicators for GPs. The British Journal of General Practice 64, e181–e190.
| Identification of an updated set of prescribing-safety indicators for GPs.Crossref | GoogleScholarGoogle Scholar | 24686882PubMed |
The American Geriatrics Society (2015) American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society 63, 2227–2246.
| American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults.Crossref | GoogleScholarGoogle Scholar | 26446832PubMed |
The Society for Post Acute and Long Term Care Medicine (2017) Top 10 particularly dangerous drug interactions in post acute/long term care. (AMDA: Columbia, MD, USA) Available at https://paltc.org/top-10-particularly-dangerous-drug-interactions-paltc [Verified 1 April 2017]
Tommelein E, Petrovic M, Somers A, Mehuys E, van der Cammen T, Boussery K (2016) Older patients’ prescriptions screening in the community pharmacy: development of the Ghent Older People’s Prescriptions community Pharmacy Screening (GheOP(3)S) tool. Journal of Public Health (Oxford, England) 38, e158–e170.
| Older patients’ prescriptions screening in the community pharmacy: development of the Ghent Older People’s Prescriptions community Pharmacy Screening (GheOP(3)S) tool.Crossref | GoogleScholarGoogle Scholar |
Wenger NS, Roth CP, Shekelle P (2007) Introduction to the assessing care of vulnerable elders‐3 quality indicator measurement set. Journal of the American Geriatrics Society 55, S247–S252.
| Introduction to the assessing care of vulnerable elders‐3 quality indicator measurement set.Crossref | GoogleScholarGoogle Scholar | 17910544PubMed |
World Health Organization (WHO) (1993) How to investigate drug use in health facilities: selected drug use indicators. No. WHO/DAP/93.1. WHO, Geneva, Switzerland.
