European Journal of Clinical Pharmacology

, Volume 69, Issue 10, pp 1845–1853

Compliance with quality prescribing indicators in terms of their relationship to financial incentives

  • Rocío Fernández Urrusuno
  • Ma Carmen Montero Balosa
  • Pastora Pérez Pérez
  • Beatriz Pascual de la Pisa
Pharmacoepidemiology and Prescription

DOI: 10.1007/s00228-013-1542-4

Cite this article as:
Fernández Urrusuno, R., Montero Balosa, M.C., Pérez Pérez, P. et al. Eur J Clin Pharmacol (2013) 69: 1845. doi:10.1007/s00228-013-1542-4



To develop quality prescribing indicators for general practitioners (GPs) who are non-monitored and not included in pay-for-performance programs, and to determine compliance with incentivized and non-incentivized indicators.

Study design

Descriptive cross sectional study. Setting: Aljarafe Primary Health Care Area (Andalusian Public Health Care Service, Spain), a rural and suburban area with a population of 323,857 inhabitants. Health assistance in this area is provided by 176 GPs in 37 health centers. Prescribing indicators were developed by a multidisciplinary group using a qualitative technique based on consensus. The members of the consensus group searched for updated recommendations focused on clinical evidence. Prescribing data were obtained from the computerised pharmacy records of reimbursed drugs and clinical data from the electronic clinical databases and hospital admission records.


Fourteen indicators based on the selection of drugs of different therapeutic groups or linked to patient´s clinical information were designed. The compliance with indicators based on the selection of drugs linked to financial incentives was higher than that of indicators not linked to financial incentives. The compliance with indicators based on clinical information varied widely. Inappropriate prescribing ranged from 7 %, in the use of long-acting beta-agonists in asthma, to 86 % in the use of drugs for the prevention of osteoporotic fractures in young women.


This study shows better compliance by GPs with indirect and incentivized quality prescribing indicators, included in pay-for-performance programs, compared with not-incentivized indicators based on the relative use of drugs and on the appropriateness prescribing.


Primary care Quality prescribing indicators Financial incentives 

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Rocío Fernández Urrusuno
    • 1
  • Ma Carmen Montero Balosa
    • 1
  • Pastora Pérez Pérez
    • 2
  • Beatriz Pascual de la Pisa
    • 3
  1. 1.Service of PharmacyAljarafe-Sevilla Norte Primary Health Care AreaMairena del AljarafeSpain
  2. 2.Andalucian Patient Safety Observatory, Agency for Health Care QualityAljarafe Primary Health Care AreaSevilleSpain
  3. 3.Family and Communitary PracticeAljarafe-Sevilla Norte Primary Health Care AreaSevilleSpain

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