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Prescribing indicators

Development and validation of guideline-based prescribing indicators as an instrument to measure the variation in the prescribing behaviour of general practitioners

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

Abstract

Background

Differences in prescribing behaviour among general practitioners (GPs).

Aim

To formulate and validate clinical prescribing indicators based on general practice guidelines.

Design

Validatory study.

Setting

Pharmacies and general practices in the Netherlands in 2003.

Participants

A total of 379 pharmacies, 947 general practices and 3.8 million patients.

Methods

A total of 51 potential indicators were formulated, based on medicinal recommendations from the evidence-based guidelines of the Dutch College of General Practitioners and the corresponding recommendations from the Commission Pharmaceutical Help of the Health Care Insurance Board. These indicators were submitted to an expert panel to assess content validity. The panel assessment was analysed using the RAND-UCLA appropriateness method (RAM). Then, for the remaining indicators, it was assessed to what extent these could be used to determine the prescribing behaviour of GPs and the level to which this behaviour varies among GPs. This was done using a prescribing analyses and cost (PACT) database that was compiled from prescription databases from 379 pharmacies, with all prescriptions from 1,434 GPs over an entire year to 3.8 million patients.

Results

The panel considered 34 of the 51 potential indicators to be valid with respect to providing an adequate reflection of the central recommendations in the guideline and in terms of relevance with respect to health gain and/or efficiency. Of these 34 indicators, 20 revealed considerable differences in the prescribing behaviour of GPs.

Conclusion

On the basis of existing general practice guidelines, 20 prescribing indicators could be formulated that were assessed by an expert panel to be sufficiently valid and which could also discriminate the prescribing behaviour of GPs as reflected in the prescription databases of pharmacies.

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Acknowledgements

We thank the following persons for their contribution towards the assessment of prescribing indicators: Luc Peeters, pharmacist, and the following general practitioners: Sjoerd Hobma, Jean Muris, Paul Stalenhoef, Frans Vissers, Ron Winkens and George Wolfs. We thank Alfons Schroten for translating the indicators into computer language. This research was funded by the Dutch Pharmacist’s Association and CZ (health insurance company).

Author information

Authors and Affiliations

  1. Division Healthcare, CZ Health Insurance Company, PO Box 55, Sittard, The Netherlands

    Paul E. M. Muijrers

  2. Department of Clinical Pharmacy and Toxicology, Maasland Hospital, Sittard, The Netherlands

    Rob Janknegt

  3. Centre for Data and Information Management, Maastricht University, Maastricht, The Netherlands

    Jildou Sijbrandij

  4. Centre for Quality of Care Research (WOK), Maastricht University and University of Nijmegen, The Netherlands

    Richard P. T. M. Grol

  5. Netherlands School of Primary Care Research, Maastricht University, Maastricht, The Netherlands

    J. André Knottnerus

  6. Kuileneindestraat 53, 6231 KE, Meerssen, The Netherlands

    Paul E. M. Muijrers

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  1. Paul E. M. Muijrers
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  2. Rob Janknegt
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  4. Richard P. T. M. Grol
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Correspondence to Paul E. M. Muijrers.

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Muijrers, P.E.M., Janknegt, R., Sijbrandij, J. et al. Prescribing indicators. Eur J Clin Pharmacol 60, 739–746 (2004). https://doi.org/10.1007/s00228-004-0821-5

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  • DOI: https://doi.org/10.1007/s00228-004-0821-5

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