General practitioners’ ranking of evidence‐based prescribing quality indicators: a comparative study with a prescription database

Abstract

BackgroundTo ensure that indicators for assessing prescribing quality are appropriate and relevant, physicians should be involved in their development. How general practitioners (GPs) rank these indicators is not fully understood. Aims(i) To determine how GPs in Ireland rank a set of evidence-based prescribing quality indicators in order of importance and relevance to their practice, and (ii) to compare the GPs' ranking of the defined set of indicators with actual prescribing practice using a prescription database. MethodsA postal questionnaire was sent to 105 GPs, who were asked to rank a set of 11 prescribing quality indicators, identified from the literature from most to least important. The results were aggregated and a weighted score for each indicator determined. These same prescribing indicators were then applied to a prescription database to compare the ranking provided with actual prescribing practice. ResultsEighty-six GPs (82%) returned the completed questionnaire. The higher ranks were for quality issues-use of inhaled corticosteroids, statins and benzodiazepines. Actual prescribing data showed prolonged use of benzodiazepines in over half of the prescriptions dispensed ( n = 18 171), 52.48% (95% confidence interval 51.95, 53.01) and low usage of generic drugs, 17.78% (17.70, 17.90) despite their high ranking by the GPs. ConclusionWhile GPs have diverse views about the value of different prescribing quality indicators, the results suggest that they do rank evidence-based guidelines on patient management highly, but those based on costs and less evidence the lowest. There was considerable divergence between theory and practice in the application of quality indices.

A review of the differences and similarities between generic drugs and their originator counterparts, including economic benefits associated with usage of generic medicines, using Ireland as a case study

“…Given that the majority of patient-doctor encounters result in the writing of a prescription [131], the cost of the medicine prescribed is of interest both to the patient/consumer and the State. The potential cost savings associated with the use of generic medicines must be considered by the bill-payers.…”

Risk perception in drug therapy

“…It is a little surprising, however, to read elsewhere in this issue of the Journal that although Irish doctors consider that generic prescribing is an index of optimum prescribing quality, generic prescribing only accounted for 18% of all prescribing in a study of 86 Dublin doctors [11]. This was despite that fact that they adhered to most of the other quality indicators that they thought reflected optimum prescribing quality, particularly when they were evidence based.…”

Psychosocial factors associated with the prescription of generic drugs

“…Generic drug prescription (GDP) is associated with reduced costs, complies with the World Health Organization rational drug use criteria [2] and is considered best practice. The self-reported Generic Drug Prescription Percentage (GDP%) by GPs in Spain was 16.7% [3] when the data were collected, which compares unfavourably with GDP% in excess of 60% in both the United Kingdom and Denmark [4] or with the USA, which has one of the highest rates of generic penetration worldwide. The aim of this study was to gain greater understanding of GDP behaviour within Primary Care settings in Asturias, a region of Northern Spain, which has a slightly lower GDP% (12.1%) than the national average [5].…”