Developing indicators of prescribing quality for primary care paediatricians

Abstract

Objective Monitoring and feedback to physicians on their prescribing patterns helps to promote change in the areas where it is needed. However, behaviour and satisfaction of general paediatricians with the routine monitoring of their prescribing has not been measured. We aimed to develop a set of valid indicators of prescribing quality in paediatric primary care practice, and to evaluate the satisfaction of paediatricians with such indicators. Methods Prescribing indicators were chosen by consensus-group technique. All paediatricians in the Primary Health Care Area, where the study took place, received feedback with indicators within 1 year. The face validity of these indicators was assessed by collecting data from anonymous questionnaires sent to the paediatricians issuing prescriptions. Key findings Twelve prescribing indicators were identified to be appropriate for assessing the quality of therapeutic management in common illness in children in primary care. Consensus was reached on four indicators suitable for application to continuous monitoring. They focused on the relative use of broad-and narrow-spectrum antibiotics, the relative use of inhaled beta-agonists and inhaled steroids and the relative use of inhaled steroids compared with leukotriene antagonists. Thirty-seven paediatricians (93%) filled out the questionnaire. Antibiotic indicators were well accepted by 92% of them. Fifty-four per cent of paediatricians thought that the proposed asthma indicators do not reflect prescribing quality for this disease. Conclusion Indicators assessing prescribing quality by primary care paediatricians should be based on anti-asthmatics and antibiotics. Periodic feedback with these indicators increases professional satisfaction and contributes to improved drug selection in the opinion of paediatricians. Opinion was divided on the use of such indicators with respect to the distribution of financial incentives.

The regional profile of antibiotic prescriptions in Italian outpatient children

“…Nevertheless, the assumption that amoxicillin, and penicillins in general [38], should be the more frequently prescribed antibiotic is supported by the evidence, since this drug is considered the first-choice treatment for the most common infectious diseases in children [2,4,[27][28][29][30]. Large differences were observed in the percentage of amoxicillin or penicillin prescriptions.…”

Impact of postal prescriber feedback on prescribing practice of Andalucian primary care paediatricians

“…All data about intervention are shown in a previous paper. [23] These educational materials supported the proposed indicators. The programme was applied, quarterly, from January 2006 until October 2007.…”

“…[9] Furthermore, another crucial factor is that PCPs showed their satisfaction with the intervention programme. [23] In an anonymous structured questionnaire, PCPs referred to having changed their own prescribing practice after having received feedback and confirmed that the continuous intervention could help them to improve drug selection. [ Impact of feedback on paediatric practice R. Fernández Urrusuno et al…”

“…Indicators of quality prescribing, specific for PCPs, were developed in a prior study with the close involvement of the professionals for whom they were intended. [23] Selected indicators focused on antibiotics and anti-asthmatics (Table 1). Indicators were applied to individual and aggregated PCP prescription data.…”

“…We have previously showed that periodic feedback with specific indicators increased PCP satisfaction and contributed to facilitating drug selection. [23] The present study was designed to assess the impact of routine feedback on prescribing of anti-asthmatics and antibiotics by PCPs. Our hypothesis was that there is a positive association between feedback and improvement in quality prescribing.…”