Skip to main content
SpringerLink
Log in

General practitioners prefer prescribing indicators based on detailed information on individual patients: a Delphi study

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Objective

To assess the face validity of both simple and advanced quality indicators for prescribing in general practice.

Methods

In a three-round Delphi study, 100 randomly selected general practitioners (GPs) in Denmark rated 18 indicators for prescribing of non-steroidal anti-inflammatory drugs. All indicators were based on prescription register data and focused on different prescribing aspects. Advanced indicators contained information at the patient level, viz. age, sex and history of drug use, while simple indicators only used drug statistics at practice level. Indicators were rated on a nine-point Likert scale. Consensus among GPs was defined as interquartile ranges of three or less. A median rating of 7–9 was interpreted as face validity and a median rating of 1–3 as no face validity.

Results

Participation in the study was accepted by 44 GPs and 37 completed all three rounds. Three indicators based on patient level data and focusing on adverse effects were assessed to have face value. One indicator focusing on costs and based on practice level data was considered unsuitable for evaluating the quality of prescribing. Consensus was not reached for the remaining indicators.

Conclusions

GPs do not regard simple indicators based on aggregated data at practice level as suitable for evaluating the prescribing quality in general practice, but prefer indicators that rest on clinical data at the patient level.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bateman DN, Eccles M, Campbell M, Soutter J, Roberts SJ, Smith JM (1996) Setting standards of prescribing performance in primary care: use of a consensus group of general practitioners and application of standards to practices in the north of England. Br J Gen Pract 46:20–25

    CAS  PubMed  Google Scholar 

  2. Steffensen FH, Schonheyder HC, Sorensen HT (1997) High prescribers of antibiotics among general practitioners—relation to prescribing habits of other drugs and use of microbiological diagnostics. Scand J Infect Dis 29:409–413

    CAS  PubMed  Google Scholar 

  3. Avery AJ, Heron T, Lloyd D, Harris CM, Roberts D (1998) Investigating relationships between a range of potential indicators of general practice prescribing: an observational study. J Clin Pharm Ther 23:441–450

    Article  CAS  PubMed  Google Scholar 

  4. Campbell SM, Cantrill JA, Roberts D (2000) Prescribing indicators for UK general practice: Delphi consultation study. BMJ 321:425–428

    Article  CAS  PubMed  Google Scholar 

  5. Coste J, Venot A (1999) An epidemiologic approach to drug prescribing quality assessment: a study in primary care practice in France. Med Care 37:1294–1307

    Article  CAS  PubMed  Google Scholar 

  6. Veninga CC, Denig P, Pont LG, Haaijer-Ruskamp FM (2001) Comparison of indicators assessing the quality of drug prescribing for asthma. Health Serv Res 36:143–161

    CAS  PubMed  Google Scholar 

  7. Cantrill JA, Sibbald B, Buetow S (1998) Indicators of the appropriateness of long-term prescribing in general practice in the United Kingdom: consensus development, face and content validity, feasibility, and reliability. Qual Health Care 7:130–135

    CAS  PubMed  Google Scholar 

  8. Majeed A, Evans N, Head P (1997) What can PACT tell us about prescribing in general practice? BMJ 315:1515–1519

    CAS  PubMed  Google Scholar 

  9. Bergman U, Popa C, Tomson Y, Wettermark B, Einarson TR, Aberg H, et al (1998) Drug utilization 90%—a simple method for assessing the quality of drug prescribing. Eur J Clin Pharmacol 54:113–118

    Article  CAS  PubMed  Google Scholar 

  10. Søndergaard J, Andersen M, Kragstrup J, Hansen P, Freng GL (2002) Why has postal prescriber feedback no substantial impact on general practitioners’ prescribing practice? A qualitative study. Eur J Clin Pharmacol 58:133–136

    Article  PubMed  Google Scholar 

  11. Glintborg D, Unkerskov J, Bach KF, Rasmussen H, Kampmann JP (2002) [NSAID—controversies]. Rationel Farmakoterapi 8:1–4 (in Danish)

    Google Scholar 

  12. Robertson J, Fryer JL, O’Connell DL, Smith AJ, Henry DA (2001) Personal formularies. An index of prescribing quality? Eur J Clin Pharmacol 57:333–341

    Article  CAS  PubMed  Google Scholar 

  13. Henry D, Lim LL, Garcia Rodriguez LA, Perez GS, Carson JL, Griffin M, et al (1996) Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. BMJ 312:1563–1566

    CAS  PubMed  Google Scholar 

  14. Laine L (2001) Approaches to non-steroidal anti-inflammatory drug use in the high-risk patient. Gastroenterology 120:594–606

    CAS  PubMed  Google Scholar 

  15. Hawkey CJ, Karrasch JA, Szczepanski L, Walker DG, Barkun A, Swannell AJ, et al (1998) Omeprazole compared with misoprostol for ulcers associated with non-steroidal anti-inflammatory drugs. Omeprazole versus Misoprostol for NSAID-Induced Ulcer Management (OMNIUM) Study Group. N Engl J Med 338:727–734

    Article  CAS  PubMed  Google Scholar 

  16. Yeomans ND, Tulassay Z, Juhasz L, Racz I, Howard JM, van Rensburg CJ, et al (1998) A comparison of omeprazole with ranitidine for ulcers associated with non-steroidal anti-inflammatory drugs Acid Suppression Trial: Ranitidine versus Omeprazole for NSAID-Associated Ulcer Treatment (ASTRONAUT) Study Group. N Engl J Med 338:719–726

    Article  CAS  PubMed  Google Scholar 

  17. Lewis SC, Langman MJ, Laporte JR, Matthews JN, Rawlins MD, Wiholm BE (2002) Dose–response relationships between individual nonaspirin non-steroidal anti-inflammatory drugs (NANSAIDs) and serious upper gastrointestinal bleeding: a meta-analysis based on individual patient data. Br J Clin Pharmacol 54:320–326

    Article  CAS  PubMed  Google Scholar 

  18. Barber N (1995) What constitutes good prescribing? BMJ 310:923–925

    CAS  PubMed  Google Scholar 

  19. Dean B, Barber N, Schachter M (2000) What is a prescribing error? Qual Health Care 9:232–237

    Article  CAS  PubMed  Google Scholar 

  20. Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR, Lazaro P, van het Loo M, et al (assessed December 2002) The RAND/UCLA Appropriateness Method User’s Manual. http://www.rand.org/publications/MR/MR1269/

  21. Jones J, Hunter D (1995) Consensus methods for medical and health services research. BMJ 311:376–380

    CAS  PubMed  Google Scholar 

  22. Cantrill JA, Sibbald B, Buetow S (1996) The Delphi and nominal group techniques in health services research. Int J Pharm Pract 4:67–74

    Google Scholar 

  23. Gaist D, Sorensen HT, Hallas J (1997) The Danish prescription registries. Dan Med Bull 44:445–448

    CAS  PubMed  Google Scholar 

  24. Campbell SM, Hann M, Roland MO, Quayle JA, Shekelle PG (1999) The effect of panel membership and feedback on ratings in a two-round Delphi survey: results of a randomized controlled trial. Med Care 37:964–968

    Article  CAS  PubMed  Google Scholar 

  25. Seager JM, Cullen DJ, Pearson G, Holmes S, Doherty M, Wilson JV, et al (2000) Ibuprofen versus other non-steroidal anti-inflammatory drugs: use in general practice and patient perception. Aliment Pharmacol Ther 14:187–191

    Article  CAS  PubMed  Google Scholar 

  26. Pont LG, Denig P, van der Molen T, van der Veen WJ, Haaijer-Ruskamp FM (2004) Validity of performance indicators for assessing prescribing quality: the case of asthma. Eur J Clin Pharmacol 59(11):833–840

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Research Unit of General Practice and Research Unit of Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Winsløwparken 19, 3, DK-5000, Odense, Denmark

    Hanne MS Rasmussen, Jens Søndergaard, Jens P Kampmann & Morten Andersen

Authors
  1. Hanne MS Rasmussen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jens Søndergaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jens P Kampmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Morten Andersen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hanne MS Rasmussen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rasmussen, H.M., Søndergaard, J., Kampmann, J.P. et al. General practitioners prefer prescribing indicators based on detailed information on individual patients: a Delphi study. Eur J Clin Pharmacol 61, 237–241 (2005). https://doi.org/10.1007/s00228-004-0870-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-004-0870-9

Keywords

Search

Navigation