UPDATE ON PRESCRIBING INDICATORS

HCQI Expert Group Meeting OECD, Paris

7th November, 2013

Prescribing indicators

Safety of prescribing in primary care

e.g. co-prescription of warfarin and ibuprofen

Quality of prescribing in primary care e.g. proportion of diabetics receiving statins

Quality Indicators

3

Proposed quality indicators

1. Use of antibiotics 1a. overall volume of antibiotics prescribed

1b. volume of cephalosporins and quinolones as a proportion of all antibiotics prescribed

2. Treatment of diabetes 2a. appropriate use of cholesterol lowering treatments 2b. use of recommended antihypertensives

3. Inappropriate use of benzodiazepines in elderly patients

3a. chronic use of benzodiazepines

3b. use of long-acting benzodiazepines

Adequate use of cholesterol lowering

treatment in diabetics

77.2

70.2 68.6

67.0 65.0 64.6

62.1

46.3

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Netherlands Spain(Catalonia)

Sweden Finland Luxembourg Slovakia (UnionHI)

Belgium Germany

Appropriate choice of antihypertensive

in diabetics

86.0 85.9 85.7

84.1

82.3 81.5 81.3

73.0

65.0

70.0

75.0

80.0

85.0

90.0

Spain(Catalonia)

Slovakia (UnionHI)

Germany Sweden Finland Netherlands Luxembourg Belgium

Safety Indicators

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Safety indicators

1. Aspirin at a dose > 75 mg daily for ≥ 1 month ≥ 65 years

2. Aspirin to a child ≤ 16 years

3. Warfarin in combination with an oral NSAID

4. Phosphodiesterase type-5 inhibitor (for example, sildenafil (=Viagra ®) to a patient who is also receiving a nitrate or nicorandil

5. Potassium salt or potassium sparing diuretic (excluding aldosterone antagonists) to a patient who is also receiving an ACE inhibitor or angiotensin II receptor antagonist

6. Verapamil to a patient who is also receiving a beta-blocker drug

Validity survey

"valid" whether sufficient evidence exists that the prescribing pattern described is harmful.

"useful" whether knowing the extent of the prescribing

pattern described could conceivably lead to policy change.

"feasible" whether mechanisms exist to collect data on the

prevalence of the prescribing pattern described.

Response

• Belgium: 2 experts

• Norway: 2 experts

• The Netherlands: 2 experts

• Sweden: 1 expert

First round rating

Indicator Valid Useful Feasible

Indicator 1: Aspirin at a dose > 75 mg daily for ≥ 1

month ≥ 65 years 8 3 6

Indicator 2: Aspirin to a child ≤ 16 years

8 4 5

Indicator 3: Warfarin in combination with an oral

NSAID 8 8 6

Indicator 4: Phosphodiesterase type-5 inhibitor (for

example, sildenafil (=Viagra ®) to a patient who is also

receiving a nitrate or nicorandil

8 7 6

Indicator 5: Potassium salt or potassium sparing

diuretic (excluding aldosterone antagonists) to a

patient who is also receiving an ACE inhibitor or

angiotensin II receptor antagonist

8 7 7

Indicator 6: Verapamil to a patient who is also

receiving a beta-blocker drug 8 7 8

Green: international consensus on appropriate validity, usefulness or feasibility Orange: international consensus not evident

Second round rating

Indicator Valid Useful Feasible

Indicator 1: Aspirin at a dose > 80 mg daily for ≥ 1

month ≥ 65 years

8 8 8

Indicator 2: Aspirin to a child ≤ 16 years

7 3 5

Indicator 3: Any anticoagulant in combination with an

oral NSAID

8 8 8

Indicator 4: Phosphodiesterase type-5 inhibitor (for

example, sildenafil (=Viagra ®) to a patient who is also

receiving a nitrate or nicorandil 6 6 8

Green: international consensus on appropriate validity, usefulness or feasibility Orange: international consensus not evident

Summary

Indicators with consensus on high validity

• Aspirin at a dose > 80 mg daily for ≥ 1 month ≥ 65 years

• Any anticoagulant in combination with an oral NSAID

• Potassium salt or potassium sparing diuretic (excluding aldosterone

antagonists) to a patient who is also receiving an ACE inhibitor or

angiotensin II receptor antagonist

• Verapamil to a patient who is also receiving a beta-blocker drug

Indicators lacking consensus on validity:

• Aspirin to a child ≤ 16 years

• Phosphodiesterase type-5 inhibitor (for example, sildenafil (=Viagra

®) to a patient who is also receiving a nitrate or nicorandil

Discussion

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