Advertisement

International Journal of Clinical Pharmacy

, Volume 33, Issue 2, pp 145–149 | Cite as

Do we need individualised prescribing quality assessment? The case of diabetes treatment

  • Petra DenigEmail author
  • Flora Haaijer-Ruskamp
Commentary
  • 243 Downloads

Abstract

Prescribing quality assessment is increasingly used in improvement programs and pay-for-performance policies. Within the area of diabetes many quality indicators have been developed. Some measure prescribing on a general level, e.g. calculating percentages of patients prescribed any statins. Others are very specific, e.g. percentages of patients with an elevated LDL-cholesterol in whom lipid-lowering treatment is started unless contraindicated or return to control within 3 months. Although the latter seems more precise, we question how far one should go in developing such indicators. Using the example of diabetes treatment, we highlight the need, opportunities, and feasibility of assessing prescribing quality in the context of individualised treatment. We conclude that it is not realistic to develop indicators that take all possible aspects of therapy non-respons, intolerance and patient preferences into account. We do recommend further development of indicators that better address subpopulations in need of adjusted treatment, such as elderly or patients with comorbidity.

References

  1. 1.
    National Committee for Quality Assurance (NCQA) HEDIS. http://www.ncqa.org. Accessed June 30 2010.
  2. 2.
    Quality and outcomes framework guidance. http://www.qof.ic.nhs.uk/. Accessed June 30 2010.
  3. 3.
    Leas BF, Berman B, Kash KM, Crawford AG, Toner RW, Goldfarb NI, Nash DB. Quality measurement in diabetes care. Popul Health Manag. 2009;12(5):265–71.PubMedCrossRefGoogle Scholar
  4. 4.
    Martirosyan L, Voorham J, Haaijer-Ruskamp FM, Braspenning J, Wolffenbuttel BHR, Denig P. A systematic literature review: prescribing indicators related to type 2 diabetes mellitus and cardiovascular risk management. Pharmacoepidemiol Drug Saf. 2010;19(4):319–34.PubMedGoogle Scholar
  5. 5.
    MacLean CH, Louie R, Shekelle PG, et al. Comparison of administrative data and medical records to measure the quality of medical care provided to vulnerable older patients. Med Care. 2006;44:141–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294(6):716–24.PubMedCrossRefGoogle Scholar
  7. 7.
    Weiss CO, Boyd CM, Yu Q, Wolff JL, Leff B. Patterns of prevalent major chronic disease among older adults in the United States. JAMA. 2007;298(10):1160–2.PubMedCrossRefGoogle Scholar
  8. 8.
    Brown AF, Mangione CM, Saliba D, Sarkisian CA; California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes. Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc. 2003;51(5 Suppl Guidelines): S265-80.Google Scholar
  9. 9.
    Wenger NS, Roth CP, Shekelle P, ACOVE Investigators. Introduction to the assessing care of vulnerable elders-3 quality indicator measurement set. J Am Geriatr Soc. 2007;55(Suppl 2):S247–52.PubMedCrossRefGoogle Scholar
  10. 10.
    Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716–24.PubMedCrossRefGoogle Scholar
  11. 11.
    Basger BJ, Chen TF, Moles RJ. Inappropriate medication use and prescribing indicators in elderly Australians: development of a prescribing indicators tool. Drugs Aging. 2008;25(9):777–93.PubMedCrossRefGoogle Scholar
  12. 12.
    Durso SC. Using clinical guidelines designed for older adults with diabetes mellitus and complex health status. JAMA. 2006;295(16):1935–40.PubMedCrossRefGoogle Scholar
  13. 13.
    Cayea D, Boyd C, Durso SC. Individualising therapy for older adults with diabetes mellitus. Drugs Aging. 2007;24(10):851–63.PubMedCrossRefGoogle Scholar
  14. 14.
    Shekelle P, Vijan S. Quality indicators for the care of diabetes mellitus in vulnerable elders. J Am Geriatr Soc. 2007;55(Suppl 2):S312–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Caughey GE, Roughead EE, Vitry AI, McDermott RA, Shakib S, Gilbert AL. Comorbidity in the elderly with diabetes: identification of areas of potential treatment conflicts. Diabetes Res Clin Pract. 2010;87(3):385–93.PubMedCrossRefGoogle Scholar
  16. 16.
    Brown SE, Meltzer DO, Chin MH, Huang ES. Perceptions of quality-of-life effects of treatments for diabetes mellitus in vulnerable and nonvulnerable older patients. J Am Geriatr Soc. 2008;56(7):1183–90.PubMedCrossRefGoogle Scholar
  17. 17.
    Huang ES, Gorawara-Bhat R, Chin MH. Self-reported goals of older patients with type 2 diabetes mellitus. J Am Geriatr Soc. 2005;53(2):306–11.PubMedCrossRefGoogle Scholar
  18. 18.
    Ashworth M, Golding S, Majeed A. Prescribing indicators and their use by primary care groups to influence prescribing. J Clin Pharm Ther. 2002;27(3):197–204.PubMedCrossRefGoogle Scholar
  19. 19.
    Garjon-Parra FJ, Aller Blanco AI, Buisan Giral MJ, Elfau Mairal M, Celaya Lecea MC. Selection of quality indicators for primary care prescription through a consensus group. Aten Prim. 2006;38(1):39–44.CrossRefGoogle Scholar
  20. 20.
    Anderson GM, Beers MH, Kerluke K. Auditing prescription practice using explicit criteria and computerized drug benefit claims data. J Eval Clin Pract. 1997;3(4):283–94.PubMedCrossRefGoogle Scholar
  21. 21.
    Steel N, Melzer D, Shekelle PG, Wenger NS, Forsyth D, McWilliams BC. Developing quality indicators for older adults: transfer from the USA to the UK is feasible. Qual Saf Health Care. 2004;13(4):260–4.PubMedCrossRefGoogle Scholar
  22. 22.
    MacKinnon NJ, Hartnell NR, Black EK, Dunbar P, Johnson J, Pattar R, Ur E. Development of clinical indicators for type 2 diabetes. Can Pharmacists J. 2009;141(2):120–8.CrossRefGoogle Scholar
  23. 23.
    Schubert I, Köster I, Ihle P, von Ferber L. Development of indicators for assessing the quality of prescribing of lipid-lowering drugs: data from the pharmacotherapeutic quality circles in Hesse, Germany. Int J Clin Pharmacol Ther. 2001;39(11):492–8.PubMedGoogle Scholar
  24. 24.
    Voorham J, Denig P, Wolffenbuttel BHR, Haaijer-Ruskamp FM. Cross-sectional versus sequential quality indicators of risk factor management in patients with type 2 diabetes. Med Care. 2008;46(2):133–41.PubMedCrossRefGoogle Scholar
  25. 25.
  26. 26.
    Hamburg MA, Collins FS. The path to personalized medicine. N Engl J Med. 2010;363(4):301–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Scholle SH, Roski J, Adams JL, Dunn DL, Kerr EA, Dugan DP, Jensen RE. Benchmarking physician performance: reliability of individual and composite measures. Am J Manag Care. 2008;14(12):833–8.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Department of Clinical PharmacologyUniversity of Groningen, UMCGGroningenNetherland

Personalised recommendations