Quality indicators for responsible use of medicines: a systematic review

Abstract

ObjectiveAll healthcare systems require valid ways to evaluate service delivery. The objective of this study was to identify existing content validated quality indicators (QIs) for responsible use of medicines (RUM) and classify them using multiple frameworks to identify gaps in current quality measurements.DesignSystematic review without meta-analysis.SettingAll care settings.Search strategyCINAHL, Embase, Global Health, International Pharmaceutical Abstract, MEDLINE, PubMed and Web of Science databases were searched up to April 2018. An internet search was also conducted. Articles were included if they described medication-related QIs developed using consensus methods. Government agency websites listing QIs for RUM were also included.AnalysisSeveral multidimensional frameworks were selected to assess the scope of QI coverage. These included Donabedian’s framework (structure, process and outcome), the Anatomical Therapeutic Chemical (ATC) classification system and a validated classification for causes of drug-related problems (c-DRPs; drug selection, drug form, dose selection, treatment duration, drug use process, logistics, monitoring, adverse drug reactions and others).Results2431 content validated QIs were identified from 131 articles and 5 websites. Using Donabedian’s framework, the majority of QIs were process indicators. Based on the ATC code, the largest number of QIs pertained to medicines for nervous system (ATC code: N), followed by anti-infectives for systemic use (J) and cardiovascular system (C). The most common c-DRPs pertained to ‘drug selection’, followed by ‘monitoring’ and ‘drug use process’.ConclusionsThis study was the first systematic review classifying QIs for RUM using multiple frameworks. The list of the identified QIs can be used as a database for evaluating the achievement of RUM. Although many QIs were identified, this approach allowed for the identification of gaps in quality measurement of RUM. In order to more effectively evaluate the extent to which RUM has been achieved, further development of QIs may be required.

Patient Safety: A Deep Concern to Caregivers

“…[9][10][11][12][13]. The cost of medication errors worldwide has been estimated as US$42 billion/year [14,15]. Doctors in US incorrectly prescribe antibiotics in nearly a third of cases.…”

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

“…QIs can be used for monitoring process performance, assessing quality improvement activities, providing feedback to More than 2400 content validated medication-related QIs exist covering most diseases and conditions. 57 These QIs for measuring adherence to medication guideline could be applied to minimize potentially inappropriate medications (eg % of persons age 65+ years prescribed antidepressants using an anticholinergic antidepressant drug). 58 In addition, QIs for polypharmacy management were developed and implemented in some countries.…”

Developing Iranian primary health care quality framework: a national study

“…The QAF includes dimensions and Quality Indicators (QIs) related for each of them to be measured and monitored [14–17]. QIs are defined as a measurement tools of health care quality, which referring to the structures, processes and outcomes of care, can be used to monitor, assess and improve the quality of care, to compare service delivery units and to determine the quality of care trends [18, 19]. QAFs are usually developed and presented at national and international levels according to their conditions [14–17].…”