New tools to measure discrepancy between prescribing practices and guideline recommendations

Abstract

The two deviation indices may be used as new tools in surveys or trials dealing with prescribing practices.

Medicine and evidence: knowledge and action in clinical practice

“…The availability of guidelines, whether local, national or international, is one issue, adherence to such guidelines, in total or in part is quite another. It is to the subject of guideline use, and the measurement thereof, that Mercier and her co‐workers [68] turn in their description of a novel method designed to measure discrepancy between prescribing practices and guideline recommendations. In this particular study, and in order to provide a quantitative measurement of clinician adherence to guideline recommendations, the authors identify three principal steps in assessing discrepancies: (i) the setting of reference prescriptions; (ii) the collection of data on prescribing practices; and (iii) the measurement of deviation between medical practices and these references.…”

“…It is on this basis that Mercier et al . [68] argue for the need for a measurement tool to identify and quantify deviation from guideline recommendations at the population level, with the availability of such a tool being a prerequisite for scientific study of deviation and appropriateness in medical care. The authors aimed to develop such a tool by identifying relevant dimensions of deviation, summarizing deviation between prescribing practices and guideline recommendations, using two approaches to quantify the total deviation on the basis of its elementary dimensions and by exploring and comparing the performances of the resulting indices of deviation through simulation of the prescribers’ behaviour facing a sample of diseases for which evidence‐based reference treatments exist and where they do not exist.…”

“…Mercier et al . [68] are convinced that the development of such techniques represent the starting point for new surveys or trials dealing with medical practice at three principal levels: (i) at an ethical level, where any prescription that does not conform to EBM is judged as a loss of chance for the patient; (ii) at a quality of healthcare level, where the aim is to provide patients with the best possible care at the lowest cost; and (iii) at the level of ‘social concern’ to integrate the concerns and imperatives of patients, doctors and policy makers.…”

The Cancer Pain Practice Index: A Measure of Evidence-Based Practice Adherence for Cancer Pain Management in Older Adults in Hospice Care

“…Mercier and colleagues6 describe tools that might be used to measure discrepancies between prescribing practices and EBP recommendations but do not report on levels of EBP adherence. A number of researchers reported using selected indicators from EBP guidelines as dependent measures of guideline adoption in non-hospice settings,7 -10 and in settings similar to home-based hospice programs where nurses provide much of the day-to-day care, investigators have evaluated utilization and adherence to clinical practice guidelines.…”