Abstract
An invitational expert meeting on indicators of prescribing quality was held on 13–15 May 2004, bringing together—from 19 European countries, the US, Canada, and Australia—40 researchers specialized in the development and application of indicators. The meeting was organized by the European Drug Utilization Research Group (EuroDURG), the Belgian National Health Insurance Institute (RIZIV-INAMI), and the World Health Organisation Regional Office for Europe (WHO-Euro). The field of prescribing quality was defined and delineated from the medical error field. A conceptual grid for classifying quality indicators was discussed, combining two axes (a drug/disease/patient axis and a structure/process/outcome axis). In addition, available databases were listed for continuous monitoring of drug utilization in Europe, with a description of the content and the richness of the collected data, as well as the impact on the potential and limitations to develop quality indicators. The importance of the origin of data for validity assessment was stressed, as data on drug utilization may originate from physician sources (prescribing data), from pharmacist or health insurer sources (distribution data), or directly from patient sources (compliance data). The different aspects of validity and their methods of assessment were listed. An overview of the (in)appropriate uses of indicators was given. The state of the art of the development and application of prescribing quality indicators in all represented countries was made, together with a first draft of a database of prescribing quality indicators, already subjected to validation procedures.
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Acknowledgements
The authors wish to thank Kees de Joncheere, Regional Officer for Pharmaceuticals, WHO-EURO, and Jo De Cock, Administrator-General of the Belgian National Health Insurance Institute, for their initial and continued support to the organisation of this meeting. This invitational meeting was funded by unconditional grants of the European Drug Utilisation Research Group (EuroDURG), the Belgian National Health Insurance Institute (RIZIV-INAMI), and the World Health Organisation Regional Office for Europe (WHO-Euro).
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The DURQUIM Scientific Committee: Andersen M, Bergman U, Chapman S, de Joncheere CP, De Swaef A, Elsevier MM, Haaijer-Ruskamp FM, Hallas J, Mol PG, Vander Stichele RH, Vlahovic V, Wettermark B.
Conference Report: Submitted to the European Journal of Clinical Pharmacology.
Annex 1: Recommendations of the drug utilisation research quality indicator meeting (DURQUIM), held in Mechelen, Belgium, 13–15 May 2004
Annex 1: Recommendations of the drug utilisation research quality indicator meeting (DURQUIM), held in Mechelen, Belgium, 13–15 May 2004
Recommendations on methodology
On taxonomy it is recommended
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To define a prescribing quality indicator as 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
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To adopt and test a taxonomy in research programs categorizing indicators as drug-, disease-, and patient-oriented indicators of prescribing quality at process and outcome level for quality indicator development
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To develop indicators of prescribing quality
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To develop disease-oriented quality indicators
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To develop indicators that include the patient preference
On the use of databases, it is recommended
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To be conscious and explicit about limitations of data sources.
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To conduct comparative studies on specific prescribing quality indicators within data sources on different levels (physician, pharmacy and patient).
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To develop a catalogue of all available databases within Europe. In particular, the availability of clinical data and treatment objectives must be considered.
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To further explain the use and ownership of such a database.
On the validity it is recommended
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To consider validation as an integral part of the development and implementation of indicators
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To consider requirements on validity in relation to the type of indicator (taxonomy) and the purpose it is used for (context)
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To provide an explicit and clear evidence base, e.g., what part of the guidelines is referred to and the extent the guidelines are up to date (content validity)
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To assess consensus procedures in relevant target groups, both in development and validation of indicators (face validity)
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To compare indicators of prescribing quality with another (gold) standard for both disease- and patient–oriented indicators, especially if indicators include proxies of indications, co-morbidity, or disease severity (concurrent validity)
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To start with a catalogue of prescribing indicators used across Europe with information on validation, use and references to guidelines, studies, and reports
On the use of indicators, it is recommended
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To have common standards of data collection
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To have common general principles for generating indicators
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To have common evidence base for quality indicators on all levels (individual to national)
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That in most cases quality indicators need information on drug as well as diagnosis or indication
Recommendations on policy
On taxonomy it is recommended
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To include or develop indicators of prescribing quality
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To include both drug- and disease-oriented quality indicators
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To promote development of disease-oriented quality indicators
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To support the development and implementation of a robust and valid methodology to select prescribing quality indicators
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To harmonise the development and/or inclusion of indicators of prescribing quality in sets of performance indicators
On databases it is recommended
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To organise and maintain a catalogue of major data sources across Europe, using EURO-MEDSTAT as a starting point
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To use a common form for description of databases
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To facilitate access to and linkage between relevant data sources
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To strengthen existing administrative drug databases on volume and expenditures by supplementing with clinical data and/or a clinical database from a population sample
On use of indicators it is recommended
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To measure prescribing quality in key disease areas on a national level and to empower prescribers
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To differentiate between quality indicators and comparators (relative markers)
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To let quality indicators lead to a payback to healthcare systems, either in saving money or better health.
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To share individual country-generated indicators when in context
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Hoven, J., Haaijer-Ruskamp, F. & Vander Stichele, R. Indicators of prescribing quality in drug utilisation research: report of a European meeting (DURQUIM, 13-15 May 2004). Eur J Clin Pharmacol 60, 831–834 (2005). https://doi.org/10.1007/s00228-004-0845-x
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DOI: https://doi.org/10.1007/s00228-004-0845-x