Validity of performance indicators for assessing prescribing quality: the case of asthma

Abstract

Validity of performance indicators for assessing prescribing quality Pont, LG; Denig, P; van der Molen, T; van der Veen, WJ; Haaijer-Ruskamp, FM Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Abstract Objectives: The aim of this study was to assess the concurrent validity between the identification of suboptimal treatment based on clinical information and computer generated indicators. Indicators that are associated with sub-optimal treatment in one of the four steps of asthma management were assessed. Design: The ability of each indicator to identify patients with sub-optimal asthma treatment from computerised general practitioner (GP) prescription records was assessed by comparing them with the results of an individual patient assessment using clinical data. Setting: Chronic asthma patients (n=146) registered with 16 Dutch GPs. Main measures: The sensitivity and positive predictive value (PPV) of each performance indicator was determined.Results: The step-1 indicator, focusing on patients not prescribed a short-acting b-agonist, had an acceptable sensitivity (0.86), but a low PPV (0.52). The two step-2 indicators, targeting under-prescription of inhaled corticosteroids, had sensitivities of 0.74 and 0.37 and PPVs of 0.46 and 0.71, respectively. The step-3 indicator, which targeted under-dosing of inhaled corticosteroids, had a sensitivity of 0.07 and a PPV of 0.2. The fourth indicator, focusing on under-prescription of long-acting b-agonists, could not be validated due to inadequate numbers of patients with severe asthma in our study sample. Discussion: None of the indicators investigated was considered valid for assessing prescriber performance, despite having good face and content validity. Performance indicators that have not been validated can only provide a broad-brush approach for assessing prescribing quality and should be used with extreme caution.

Developing a complex intervention to improve prescribing safety in primary care: mixed methods feasibility and optimisation pilot study

“…This study shows their perceived value and feasibility may vary by prescribing topic,34 42 and any research or NHS use of prescribing indicators for improvement would therefore benefit from piloting and evaluation. Some prescribing topics, such as NSAIDs, may be suitable for low-intensity interventions based on repeated feedback using existing electronic data, simple education and possibly small financial incentives but other prescribing topics, such as ‘asthma control’ and ‘antithrombotics in AF’ may require prior work to clean electronic data and refine measures, or more intensive educational work to persuade practices what is being measured is important, or more intensive facilitation of change.…”

“…Although there are many examples of studies developing prescribing measures and establishing their face and content validity,5 30–33 few have reported the extent to which such measures can identify actual opportunities for improvement 34 35. A Dutch study found that patients identified by a measure-targeting underuse of inhaled corticosteroids in asthma (using prescriptions of short-acting β agonists as a proxy for uncontrolled asthma), 46% were candidates for inhaled steroids after a face-to-face review by a clinician, compared with 25% at best (assuming all ‘further investigations’ would confirm the need for inhaled steroids).…”

Physician and patient characteristics associated with prescriptions and costs of drugs in the Lazio region of Italy

“…Prescribing medications is one of the most important therapeutic activities of a general practitioner (GP) and the quality of such practices is a relevant issue [1]. There are many determinants that can affect attitudes towards prescribing drugs, such as patients' socio-demographic variables, and the GPs' characteristics.…”

Evaluation of Drug Use Patterns of Out Patient Attendees in a Tertiary Care Teaching Hospital in Dermatology and Venereology Department as a Tool to Promote Rational Prescribing

“…The information on quality of health care is being demanded by policy makers, healthcare professionals and the general public 3 . Standards setting and assessment of the quality care through performance review should be part of everyday practice 4 .…”