The quality of prescribing in general practice

Holden, John; Wilson, Robert

doi:10.1108/09526869610125000

Cited by 6 publications

(4 citation statements)

References 44 publications

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“…Quality indicators are defined as explicitly defined measurable items of antibiotic use giving a possible indication of the level of quality,7 8 focusing on different aspects of quality (effectiveness, safety, appropriateness and costs9; compliance and persistence) and relevant for clinical practice 10. A prescribing quality indicator is a measurable element of prescribing performance, for which there is evidence or consensus that it can be used to assess quality and, hence, be used in changing the quality of care provided 11.…”

Section: Methodsmentioning

confidence: 99%

European Surveillance of Antimicrobial Consumption (ESAC): disease-specific quality indicators for outpatient antibiotic prescribing

Adriaenssens

Coenen²,

Tonkin‐Crine³

et al. 2011

BMJ Quality & Safety

156

151

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Background: In 2007, ESAC (http://www.esac.ua.ac.be) published a set of 12 valid drug-specific quality indicators for outpatient antibiotic use in Europe. In this study, the authors aimed to develop evidence-based disease-specific quality indicators for outpatient antibiotic prescribing in Europe. Methods: Two meetings were convened to produce a list of disease-specific quality indicators for outpatient antibiotic prescribing which conform to internationally agreed recommendations, building on a similar development of drug-specific quality indicators, and in collaboration with CHAMP and HAPPY AUDIT. 62 experts were asked to complete two scoring rounds of the proposed indicators on seven dimensions: their relevance to (1) reducing antimicrobial resistance, (2) patient health benefit, (3) cost-effectiveness, (4) policy makers, (5) individual prescribers, (6) their evidence base and (7) their range of acceptable use, using a scale ranging from 1 (¼completely disagree) to 9 (¼completely agree). Scores were judged according to the UCLA-RAND appropriateness method. Results: For the six main indications for antibiotic prescribing (acute otitis media, acute upperrespiratory infection, acute/chronic sinusitis, acute tonsillitis, acute bronchitis/bronchiolitis, cystitis/other urinary infection) and for pneumonia, three quality indicators were proposed, the percentage prescribed (a) antibiotics; (b) recommended antibiotics; (c) quinolones. This set was scored by 40 experts from 25 countries. After one scoring round, all indicators were already rated as relevant on all dimensions, except one. Conclusion: All proposed disease-specific quality indicators for outpatient antibiotic prescribing have face validity and are potentially applicable. They could be used to better describe antibiotic use and assess the quality of antibiotic prescribing patterns in ambulatory care.

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Section: Methodsmentioning

confidence: 99%

European Surveillance of Antimicrobial Consumption (ESAC): disease-specific quality indicators for outpatient antibiotic prescribing

Adriaenssens

Coenen²,

Tonkin‐Crine³

et al. 2011

BMJ Quality & Safety

156

151

View full text Add to dashboard Cite

show abstract

“…Quality indicators are defined as explicitly defined measurable items of antibiotic use giving a possible indication of the level of quality,19 20 focusing on different aspects of quality (effectiveness, safety, appropriateness and costs,21 compliance, and persistence) and relevant to clinical practice 22. To produce a list of proposed quality indicators for outpatient antibiotic use in Europe based on ESAC data, a workshop was convened, funded by the European Science Foundation (ESF) (see fig 1 for a flowchart of the stages of development) 18.…”

Section: Methodsmentioning

confidence: 99%

European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibiotic use in Europe

Coenen

Ferech

Haaijer‐Ruskamp

et al. 2007

Quality and Safety in Health Care

173

136

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ESAC data. Participants scored the relevance of each indicator to reducing antimicrobial resistance, patient health benefit, cost effectiveness and public health policy makers (scale: 1 (completely disagree) to 9 (completely agree)). The scores were processed according to the UCLA-RAND appropriateness method. Indicators were judged relevant if the median score was not in the 1-6 interval and if there was consensus (number of scores within the 1-3 interval was fewer than one third of the panel). From the relevant indicators providing overlapping information, the one with the highest scores was selected for the final set of quality indicators-values were updated with 2004 ESAC data. Results: 22 participants (12 countries) completed scoring of a set of 22 proposed indicators. Nine were rated as relevant antibiotic prescribing indicators on all four dimensions; five were rated as relevant if only relevance to reducing antimicrobial resistance and public health policy makers was taken into account. A final set of 12 indicators was selected. Conclusion: 12 of the proposed ESAC-based quality indicators for outpatient antibiotic use in Europe have face validity and are potentially applicable. These indicators could be used to better describe antibiotic use in ambulatory care and assess the quality of national antibiotic prescribing patterns in Europe.

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“…These range across disciplines; hospitals and general practice; regulatory, managerial and educational strategies; and all attributes of QUM, which include efficacy, effectiveness, equity, safety, appropriateness and costs. 14 Safety is an increasing priority. An estimated 16% of hospitalised patients suffer an adverse event, with 50% of these events being preventable.…”

Section: Safety and Quality In The Use Of Medicinesmentioning

confidence: 99%

Doctor and pharmacist — back to the apothecary!

Liaw¹,

Peterson²

2009

Aust. Health Review

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The Australian National Medicines Policy embodies four tenets: availability, quality, safety and efficacy of medicines; timely access to affordable medicines; quality use of medicines (QUM); and a responsible and viable medicines industry. The promotion of QUM requires a multidisciplinary approach, including contributions from government, the pharmaceutical industry, health professionals, consumers and academia. However, there are significant tensions and unintended effects associated with the multidisciplinary approach, especially with the relationships between prescribers and dispensers of medicines.The general practitioner and the pharmacist share a common ancestor -the apothecary. The separation of dispensing from prescribing, which began in medieval Europe and 19th century England, reframed and confined the patient-doctor relationship to one of diagnosis, prescription and non-drug management. The role of pharmacists was limited to dispensing, though the present trend is for their responsibilities to be widened. Historical antecedents, the contribution of an increasing number of actors to the costs of health care, universal health insurance and an evolving regulatory framework, are among the factors influencing doctor-pharmacist relations.The prescribing and dispensing of medicines must be guided by an ethical clinical governance structure encompassing health professionals, regulators, the pharmaceutical industry and consumers. There must be close monitoring of safety and effectiveness, and promotion of quality use of medicines and improved patient outcomes. Ongoing training and professional development, within and across professional boundaries, is essential to support harmonious and cost-effective interprofessional practice. The approach must be "apothecarial" with complementary roles and responsibilities for the prescriber and dispenser within the patient-clinician therapeutic relation- ship, and not adversarial.

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The quality of prescribing in general practice

Cited by 6 publications

References 44 publications

European Surveillance of Antimicrobial Consumption (ESAC): disease-specific quality indicators for outpatient antibiotic prescribing

European Surveillance of Antimicrobial Consumption (ESAC): disease-specific quality indicators for outpatient antibiotic prescribing

European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibiotic use in Europe

Doctor and pharmacist — back to the apothecary!

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The quality of prescribing in general practice

Cited by 6 publications

References 44 publications

European Surveillance of Antimicrobial Consumption (ESAC): disease-specific quality indicators for outpatient antibiotic prescribing

European Surveillance of Antimicrobial Consumption (ESAC): disease-specific quality indicators for outpatient antibiotic prescribing

European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibiotic use in Europe

Doctor and pharmacist &mdash; back to the apothecary!

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Doctor and pharmacist — back to the apothecary!