Development of prescribing indicators for elderly medical inpatients

Abstract

These prescribing indicators are sensitive to inappropriate prescribing for elderly medical inpatients and cover a wide range of therapeutic areas. They should enable changes in prescribing quality to be measured objectively. Interhospital variation in casemix resulted in substantial differences in the proportion of patients in whom it would have been appropriate to prescribe specific drugs or combinations and prevented derivation of reference ranges of optimal prescribing for four indicators.

Prescribing for older people

“…38 Changes in pharmacodynamics and pharmacokinetics mean that these patients often need lower doses, and the presence of multiple medical problems Box 2 Types of prescribing quality indicators 35 Quantitative indicators Such as the mean number of drugs prescribed or the number classified in the British National Formulary as "black triangle" or "less suitable for prescribing." 11 These indicators are best used in conjunction with others…”

“…Furthermore, amalgamated data distance the prescriber from specific errors and make it harder to see obvious ways to improve. Audit does not necessarily change behaviour, 34 but prescribing indicators have been developed for older patients, [35][36][37] which could provide immediate feedback when integrated into electronic prescribing systems. Box 2 shows the types of indicators used to assess prescribing quality.…”

Indicators of the appropriateness of long-term prescribing in general practice in the United Kingdom: consensus development, face and content validity, feasibility, and reliability

“…A more recent study has gone some way towards developing indicators to look more broadly at prescribing for individual patients. 6 In this study, we have rejected the approach of deriving quality indicators from clinical guidelines as these are necessarily focused on specific conditions or drugs. Clinical guidelines focus on disease management, not patient management, and so may neglect interactions between treatment regimes in patients with two or more chronic conditions.…”

Assessment of quality of prescribing in patients of hypertension at primary and secondary health care facilities using the Prescription Quality Index (PQI) tool

“…These tools are based on expert judgment or consensus of practitioners[1234] without any information on the psychometric properties of the instruments. These tools measure of quality of care in general[5] or for specific disease,[4] in specific population,[67] overall use,[8] specific areas of use,[910] or specific drug or groups of drugs. [71112]…”

“…These tools measure of quality of care in general[5] or for specific disease,[4] in specific population,[67] overall use,[8] specific areas of use,[910] or specific drug or groups of drugs. [71112]…”