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Batista AM, Gama ZADS, Hernández PJS, Souza D. Quality of prescription writing in Brazilian primary health care. Prim Health Care Res Dev 2023; 24:e49. [PMID: 37522367 PMCID: PMC10466202 DOI: 10.1017/s1463423623000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE To evaluate the quality of prescription writing in the context of public primary health care. BACKGROUND Prescription errors are one of the leading patient safety problems in primary care and can be caused by errors in therapeutic decisions or in the quality of prescription writing. METHODS Cross-sectional observational study conducted in a municipality in Northeastern Brazil. The assessment instrument (including 13 indicators and one composite indicator) was applied to a representative sample of drug prescriptions from the 24 Family Health Teams providing Primary Health Care in the municipality, dispensed in January 2021. Estimates of compliance and their 95% confidence intervals and graphical analysis of frequencies are assessed globally and stratified by dispensing units and prescribers. FINDINGS The average composite prescription writing quality on a 0-100 scale was 60.2 (95% CI 57.8-62.6). No quality criteria had 100% compliance. The highest compliance rates were found for 'frequency of administration' (98.9%) and 'identification of the prescriber' (98.9%). On the other hand, 'recorded information on allergy' (0.0%), 'patient's date of birth' (1.7%), 'nonpharmacological recommendations' (1.7%), and 'guidance on the use of the drug' (25%) were the indicators with lower compliance, contributing to 69% of the noncompliances found. The type and frequency of the errors in the quality of prescription writing uncovered in this study confirm the continuing need to tackle this problem to improve patient safety. The results identify priority aspects for interventions and further studies on the quality of prescription writing in the context of Primary Health Care in Brazil.
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Affiliation(s)
- Almária Mariz Batista
- Multicampi School of Medical Sciences, Federal University of Rio Grande do Norte, Caicó, Brazil
- Instituto Nacional de Salud Pública, Cuernavaca, México
| | | | | | - Dyego Souza
- Department of Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Graduate Programme in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
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Mariz Batista A, da Silva Gama ZA, Souza D. Validation of the QualiPresc instrument for assessing the quality of drug prescription writing in primary health care. PLoS One 2022; 17:e0267707. [PMID: 35544534 PMCID: PMC9094502 DOI: 10.1371/journal.pone.0267707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/13/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Adverse events related to drug prescriptions are the main patient safety issue in primary care; however there is a lack of validated instruments for assessing the quality of prescription writing, which covers the prescriber, the patient and the drug information. OBJECTIVE To develop and validate the QualiPresc instrument to assess and monitor the quality of drug prescriptions in primary care, accompanied by a self-instruction direction, with the goal of filling the gap in validated instruments to assess the quality of prescription writing. METHODOLOGY A validation study conducted in a municipality in Northeastern Brazil, based on prescriptions prepared in January 2021 by physicians assigned to 18 Basic Health Units and filed in 6 distribution/dispensing units. Four steps were covered: 1) Analysis of content validity of each indicator (relevance and adequacy); 2) Analysis of reliability via intra and inter-rater agreement of each indicator; 3) Analysis of the utility of each indicator; 4) Construction and analysis of the reliability of a weighted composite indicator based on effectiveness and safety scores for each indicator. RESULTS Twenty-nine potential indicators were listed, but only 13 were approved for validity, reliability and usefulness. Twelve indicators were excluded because of validity (<90% validity index) and four because they were not useful in the context of the study. Three weighted composite indicators were tested, but only one was approved for reliability and usefulness. The validated instrument therefore contains 13 indicators and 1 weighted composite indicator. CONCLUSION This study demonstrates the validity, reliability and usefulness of QualiPresc for the evaluation of prescription writing in the context of primary care. Application to contexts such as secondary care and tertiary care requires cross-cultural adaptation and new content validity. Educators, managers and health care professionals can access QualiPresc online, free of charge, to assess performance and provide feedback involving drug prescribers.
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Affiliation(s)
- Almária Mariz Batista
- Escola Multicampi de Ciências Médicas, Universidade Federal do Rio Grande do Norte, Caicó, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | | | - Dyego Souza
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Brazil
- Departamento de Saúde Coletiva, Universidade Federal do Rio Grande do Norte, Natal, Brazil
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Barry E, Moriarty F, Boland F, Bennett K, Smith SM. The PIPc Study-application of indicators of potentially inappropriate prescribing in children (PIPc) to a national prescribing database in Ireland: a cross-sectional prevalence study. BMJ Open 2018; 8:e022876. [PMID: 30344174 PMCID: PMC6196813 DOI: 10.1136/bmjopen-2018-022876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Evidence is limited regarding the quality of prescribing to children. The objective of this study was to apply a set of explicit prescribing indicators to a national pharmacy claims database (Primary Care Reimbursement Service) to determine the prevalence of potentially inappropriate prescribing in children (PIPc) in primary care. PRIMARY AND SECONDARY OUTCOMES MEASURES To determine the overall prevalence of potentially inappropriate prescribing (PIP) in children in primary care. To examine the prevalence of PIPc by gender. DESIGN AND SETTING Cross-sectional study. Application of indicators of commission of PIP and omission of appropriate prescribing to a national prescribing database in Ireland. PARTICIPANTS Eligible children <16 years of age who were prescribed medication in 2014. RESULTS Overall prevalence of PIPc by commission was 3.5% (95% CI 3.5% to 3.6%) of eligible children <16 years of age who were prescribed medication in 2014. Overall prevalence of PIPc by omission was 2.5% (95% CI 2.5% to 2.6%) which rose to 11.5% (95% CI 11.4% to 11.7%) when prescribing of spacer devices for children with asthma was included. The most common individual PIPc by commission was the prescribing of carbocisteine to children (3.3% of eligible children). The most common PIPc by omission (after excluding spacer devices) was failure to prescribe an emollient to children prescribed greater than one topical corticosteroid (54% of eligible children). PIPc by omission was significantly higher in males compared with females (relative risk (RR) 1.3; 95% CI 1.0 to 1.7) but no different for PIPc by commission (RR 1.0; 95% CI 0.7 to 1.6). CONCLUSION This study shows that the overall prevalence of PIP in children is low, although results suggest room for improved adherence to asthma guidelines.
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Affiliation(s)
- Emma Barry
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Moriarty
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona Boland
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences (PHS), Royal College of Surgeons, Dublin, Ireland
| | - Susan M Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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Rubak S, Høst A, Christensen LB, Langfrits MS, Thomsen RW. Validity of asthma diagnoses and patterns of anti-asthmatic drug use in a cohort of 2053 Danish children. Health Sci Rep 2018; 1:e77. [PMID: 30623100 PMCID: PMC6266370 DOI: 10.1002/hsr2.77] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/05/2018] [Accepted: 06/18/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND AIMS When investigating and treating asthma in children, diagnosing must be precise and valid. There is a need for studies researching asthma in children showing how to use registry-based, epidemiological data. We examined the feasibility and validity of using anti-asthmatic drug prescription data to identify children with asthma and assessed medication patterns in children with and without confirmed asthma. METHODS We used population-based Danish prescription data and hospital discharge registries to identify all children aged 0 to 14 years who had redeemed at least one prescription for an inhaled anti-asthmatic drug. Individual asthma cases were validated by hospital discharge information and by their treating general practitioners according to international asthma guidelines. RESULTS In total, 2053 children, out of a population of 20181, had redeemed at least one prescription of any inhaled anti-asthmatic drug. The positive predictive value (PPV) of having two different asthma medications prescribed in 1 year was 80.2% for presence of true asthma, with a sensitivity of 59%. Corresponding estimates of PPV/sensitivity of at least one prescription for an inhaled corticosteroid (ICS) were 79% and 58%, respectively, while the true asthma PPV with at least one LABA prescription increased to 97%. Among children with confirmed asthma, one-third had not used Beta2-agonist therapy as part of their treatment. Conversely, among children without confirmed asthma, 40% were prescribed a minimum of two prescriptions for any kind of inhaled anti-asthmatic drug, and 12% and 9% used an ICS or Leukotriene receptor antagonist, respectively. CONCLUSIONS Anti-asthmatic drug prescription data could be used to identify children with true asthma, with reasonable accuracy. The observed pattern of anti-asthmatic medication usage among children with and without confirmed asthma suggests that there is room for therapeutic improvement.
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Affiliation(s)
- Sune Rubak
- Department of Child and Adolescent HealthAarhus University Hospital SkejbyAarhusDenmark
| | - Arne Høst
- Department of PediatricsOdense University HospitalOdenseDenmark
| | - Lotte Brix Christensen
- Department of Clinical Epidemiology, Institute of Clinical MedicineAarhus University HospitalAarhusDenmark
| | | | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Institute of Clinical MedicineAarhus University HospitalAarhusDenmark
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Tyrstrup M, van der Velden A, Engstrom S, Goderis G, Molstad S, Verheij T, Coenen S, Adriaenssens N. Antibiotic prescribing in relation to diagnoses and consultation rates in Belgium, the Netherlands and Sweden: use of European quality indicators. Scand J Prim Health Care 2017; 35:10-18. [PMID: 28277045 PMCID: PMC5361413 DOI: 10.1080/02813432.2017.1288680] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the quality of antibiotic prescribing in primary care in Belgium, the Netherlands and Sweden using European disease-specific antibiotic prescribing quality indicators (APQI) and taking into account the threshold to consult and national guidelines. DESIGN A retrospective observational database study. SETTING Routine primary health care registration networks in Belgium, the Netherlands and Sweden. SUBJECTS All consultations for one of seven acute infections [upper respiratory tract infection (URTI), sinusitis, tonsillitis, otitis media, bronchitis, pneumonia and cystitis] and the antibiotic prescriptions in 2012 corresponding to these diagnoses. MAIN OUTCOME MEASURES Consultation incidences for these diagnoses and APQI values (a) the percentages of patients receiving an antibiotic per diagnosis, (b) the percentages prescribed first-choice antibiotics and (c) the percentages prescribed quinolones. RESULTS The consultation incidence for respiratory tract infection was much higher in Belgium than in the Netherlands and Sweden. Most of the prescribing percentage indicators (a) were outside the recommended ranges, with Belgium deviating the most for URTI and bronchitis, Sweden for tonsillitis and the Netherlands for cystitis. The Netherlands and Sweden prescribed the recommended antibiotics (b) to a higher degree and the prescribing of quinolones exceeded the proposed range for most diagnoses (c) in Belgium. The interpretation of APQI was found to be dependent on the consultation incidences. High consultation incidences were associated with high antibiotic prescription rates. Taking into account the recommended treatments from national guidelines improved the results of the APQI values for sinusitis in the Netherlands and cystitis in Sweden. CONCLUSION Quality assessment using European disease-specific APQI was feasible and their inter-country comparison can identify opportunities for quality improvement. Their interpretation, however, should take consultation incidences and national guidelines into account. Differences in registration quality might limit the comparison of diagnosis-linked data between countries, especially for conditions such as cystitis where patients do not always see a clinician before treatment. Key points The large variation in antibiotic use between European countries points towards quality differences in prescribing in primary care. • The European disease-specific antibiotic prescribing quality indicators (APQI) provide insight into antibiotic prescribing, but need further development, taking into account consultation incidences and country-specific guidelines. • The incidence of consultations for respiratory tract infections was almost twice as high in Belgium compared to the Netherlands and Sweden. • Comparison between countries of diagnosis-linked data were complicated by differences in data collection, especially for urinary tract infections.
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Affiliation(s)
- Mia Tyrstrup
- Department of Clinical Sciences, General Practice, Lund University, Lund, Sweden
- CONTACT Mia Tyrstrup Department of Clinical Sciences, General Practice, Lund University, Lund, Sweden
| | - Alike van der Velden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sven Engstrom
- Primary Care Research and Development Unit, Jönköping, Sweden
| | - Geert Goderis
- Katholieke Universiteit Leuven, Academic Center for General Practice, Leuven, Belgium
| | - Sigvard Molstad
- Department of Clinical Sciences, General Practice, Lund University, Lund, Sweden
| | - Theo Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Samuel Coenen
- Department of Primary and Interdisciplinary Care (ELIZA), Center for General Practice, University of Antwerp, Antwerp, Belgium
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - Niels Adriaenssens
- Department of Primary and Interdisciplinary Care (ELIZA), Center for General Practice, University of Antwerp, Antwerp, Belgium
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
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Lönnbro J, Wallerstedt SM. Clinical relevance of the STOPP/START criteria in hip fracture patients. Eur J Clin Pharmacol 2017; 73:499-505. [PMID: 28050623 PMCID: PMC5350233 DOI: 10.1007/s00228-016-2188-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/20/2016] [Indexed: 01/08/2023]
Abstract
Purpose The aim of this study was to investigate the clinical relevance of potentially inappropriate medications (PIMs), identified by the STOPP criteria, and potential prescribing omissions (PPOs), identified by the START criteria, and to identify predictors for clinically relevant PIMs and PPOs. Methods The STOPP and START criteria were applied on the medication lists of 200 older hip fracture patients, consecutively recruited to a randomized controlled study in 2009. For each identified PIM and/or PPO, the clinical relevance was assessed at the individual level, using medical records from both hospital and primary care as well as data collected in the original study. Results A total of 555 PIMs/PPOs were identified in 170 (85%) patients (median age: 85 years, 67% female), 298 (54%) of which, in 141 (71%) patients, were assessed as clinically relevant. A greater proportion of PIMs than PPOs were clinically relevant: 71% (95% CI: 66%; 76%) vs. 32% (27%; 38%). A greater proportion of PPOs than PIMs could not be assessed with available information: 38% (32%; 44%) vs. 22% (17%; 27%). Number of drugs and multidose drug dispensing, but not age, sex, cognition, or nursing home residence, were associated with ≥1 clinically relevant PIMs/PPOs. Conclusions The present study illustrates that one in two PIMs/PPOs identified by the STOPP/START criteria is clearly clinically relevant, PIMs being clinically relevant to a greater extent than PPOs. Based on available information, the clinical relevance could not be determined in a non-negligible proportion of PIMs/PPOs. Number of drugs and multidose drug dispensing were associated with ≥1 clinically relevant PIMs/PPOs.
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Affiliation(s)
- Johan Lönnbro
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanna M Wallerstedt
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, SE-413 90, Gothenburg, Sweden.
- Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Pont LG, Morgan TK, Williamson M, Haaijer FM, van Driel ML. Validity of prescribing indicators for assessing quality of antibiotic use in Australian general practice. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:66-74. [PMID: 27774679 DOI: 10.1111/ijpp.12318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/08/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to assess the validity of a set of European quality indicators for assessing antimicrobial prescribing in Australian General Practice. METHODS A modified UCLA/RAND appropriateness method was used to assess the validity of 30 antimicrobial prescribing indicators. An expert panel of 12 general practitioners scored the validity of each indicator for measuring quality in Australian general practice. Four quality domains were considered: monitoring antibiotic resistance, benefit to individual patients, value for money and value to policymakers. Panel members were also asked to comment on the relevance to the Australian context and proposed benchmarks for each indicator. KEY FINDINGS All panel members were in agreement regarding the validity of each indicator in each of the specified domains with exception of the indicator assessing the use of systemic antibiotics for pneumonia. The majority of the indicators and their associated benchmarks were considered valid for assessing quality in Australian General Practice, however, there were differences regarding the quality domain that each indicator was considered valid for. Monitoring quality considering individual patient benefit was the most problematic domain with respect to validity. CONCLUSIONS This study demonstrates the validity of 30 European indicators for assessing quality of antimicrobial prescribing in general practice in a non-European setting and provides guidance regarding acceptable benchmarks for the indicators. With international concerns regarding misuse of antibiotics and global interest in prescribing quality, valid evidence-based antimicrobial prescribing indicators and associated benchmarks are an essential tool for assessing prescribing quality.
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Affiliation(s)
- Lisa G Pont
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
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Barry E, O'Brien K, Moriarty F, Cooper J, Redmond P, Hughes CM, Bennett K, Fahey T, Smith SM. PIPc study: development of indicators of potentially inappropriate prescribing in children (PIPc) in primary care using a modified Delphi technique. BMJ Open 2016; 6:e012079. [PMID: 27601499 PMCID: PMC5020844 DOI: 10.1136/bmjopen-2016-012079] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE There is limited evidence regarding the quality of prescribing for children in primary care. Several prescribing criteria (indicators) have been developed to assess the appropriateness of prescribing in older and middle-aged adults but few are relevant to children. The objective of this study was to develop a set of prescribing indicators that can be applied to prescribing or dispensing data sets to determine the prevalence of potentially inappropriate prescribing in children (PIPc) in primary care settings. DESIGN Two-round modified Delphi consensus method. SETTING Irish and UK general practice. PARTICIPANTS A project steering group consisting of academic and clinical general practitioners (GPs) and pharmacists was formed to develop a list of indicators from literature review and clinical expertise. 15 experts consisting of GPs, pharmacists and paediatricians from the Republic of Ireland and the UK formed the Delphi panel. RESULTS 47 indicators were reviewed by the project steering group and 16 were presented to the Delphi panel. In the first round of this exercise, consensus was achieved on nine of these indicators. Of the remaining seven indicators, two were removed following review of expert panel comments and discussion of the project steering group. The second round of the Delphi process focused on the remaining five indicators, which were amended based on first round feedback. Three indicators were accepted following the second round of the Delphi process and the remaining two indicators were removed. The final list consisted of 12 indicators categorised by respiratory system (n=6), gastrointestinal system (n=2), neurological system (n=2) and dermatological system (n=2). CONCLUSIONS The PIPc indicators are a set of prescribing criteria developed for use in children in primary care in the absence of clinical information. The utility of these criteria will be tested in further studies using prescribing databases.
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Affiliation(s)
- Emma Barry
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kirsty O'Brien
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Moriarty
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Janine Cooper
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Patrick Redmond
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carmel M Hughes
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Kathleen Bennett
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tom Fahey
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
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Affiliation(s)
- Emma Barry
- Health Research Board Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Susan M Smith
- Health Research Board Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons, 123 St. Stephen's Green, Dublin 2, Ireland.
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Wallerstedt SM, Belfrage B, Fastbom J. Association between drug-specific indicators of prescribing quality and quality of drug treatment: a validation study. Pharmacoepidemiol Drug Saf 2015; 24:906-14. [PMID: 26147790 PMCID: PMC4758385 DOI: 10.1002/pds.3827] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 06/02/2015] [Accepted: 06/08/2015] [Indexed: 11/06/2022]
Abstract
Purpose To evaluate the concurrent validity of three European sets of drug‐specific indicators of prescribing quality Methods In 200 hip fracture patients (≥65 years), consecutively recruited to a randomized controlled study in Sahlgrenska University Hospital in 2009, quality of drug treatment at study entry was assessed according to a gold standard as well as to three drug‐specific indicator sets (Swedish National Board of Health and Welfare, French consensus panel list, and German PRISCUS list). As gold standard, two specialist physicians independently assessed and then agreed on the quality for each patient, after initial screening with STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) and START (Screening Tool to Alert to Right Treatment). Results According to the Swedish, French, and German indicator sets, 82 (41%), 54 (27%), and 43 (22%) patients had potentially inappropriate drug treatment. A total of 141 (71%) patients had suboptimal drug treatment according to the gold standard. The sensitivity for the indicator sets was 0.51 (95% confidence interval: 0.43; 0.59), 0.33 (0.26; 0.41), and 0.29 (0.22; 0.37), respectively. The specificity was 0.83 (0.72; 0.91), 0.88 (0.77; 0.94), and 0.97 (0.88; 0.99). Suboptimal drug treatment was 2.0 (0.8; 5.3), 1.9 (0.7; 5.1), and 6.1 (1.3; 28.6) times as common in patients with potentially inappropriate drug treatment according to the indicator sets, after adjustments for age, sex, cognition, residence, multi‐dose drug dispensing, and number of drugs. Conclusions In this setting, the indicator sets had high specificity and low sensitivity. This needs to be considered upon use and interpretation. Copyright © 2015 The Authors Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Johan Fastbom
- Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
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Rottenkolber M, Fischer R, Ibáñez L, Fortuny J, Reynolds R, Amelio J, Gerlach R, Tauscher M, Thürmann P, Hasford J, Schmiedl S. Prescribing of long-acting beta-2-agonists/inhaled corticosteroids after the SMART trial. BMC Pulm Med 2015; 15:55. [PMID: 25943421 PMCID: PMC4428117 DOI: 10.1186/s12890-015-0051-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 04/22/2015] [Indexed: 11/14/2022] Open
Abstract
Background After the SMART trial evaluating the safety of salmeterol (long-acting beta-2-agonist (LABA)) in asthma patients, regulatory actions were taken to promote a guideline-adherent prescribing of LABA only to patients receiving inhaled corticosteroids (ICS). We aim to analyse LABA- and ICS-related prescription patterns after the SMART trial in Germany. Methods Patients documented in the Bavarian Association of Statutory Health Insurance Physicians database (approximately 10.5 million people) were included if they had a diagnosis of asthma and at least one prescription of LABA and/or ICS between 2004 and 2008. Annual period prevalence rates (PPRs) were estimated and Cochrane Armitage tests were used for time trend analyses. Results Highest annual PPRs were found for budesonide and the fixed combination of salmeterol/fluticasone. The proportion of “concomitant LABA and ICS users” increased from 52.0 to 57.6% within the study period, whereas for “LABA users without ICS” a slight decrease from 6.5 to 5.4% was found. In 2008, the proportion of patients with at least one quarter with a LABA prescription without concomitant ICS was highest in elderly, male patients (≈20%). In the majority of these patients, a concomitant diagnosis of COPD (i.e. asthma-COPD overlap syndrome [ACOS]) was present. Conclusions Between 2004 and 2008, we found a moderate increase in guideline-adherent LABA prescribing in a representative German population. Elderly men received a significant number of LABA prescriptions without concomitant ICS probably due to ACOS. Electronic supplementary material The online version of this article (doi:10.1186/s12890-015-0051-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marietta Rottenkolber
- Institute for Medical Information Sciences, Biometry, and Epidemiology, Ludwig-Maximilians-Universitaet, Marchioninistr. 15, D-81377, Munich, Germany.
| | | | - Luisa Ibáñez
- Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. .,Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | | | | | | | - Roman Gerlach
- National Association of Statutory Health Insurance Physicians of Bavaria, Munich, Germany.
| | - Martin Tauscher
- National Association of Statutory Health Insurance Physicians of Bavaria, Munich, Germany.
| | - Petra Thürmann
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany. .,Philipp Klee-Institute for Clinical Pharmacology, HELIOS Clinic Wuppertal, Wuppertal, Germany.
| | - Joerg Hasford
- Institute for Medical Information Sciences, Biometry, and Epidemiology, Ludwig-Maximilians-Universitaet, Marchioninistr. 15, D-81377, Munich, Germany.
| | - Sven Schmiedl
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany. .,Philipp Klee-Institute for Clinical Pharmacology, HELIOS Clinic Wuppertal, Wuppertal, Germany.
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Selección de indicadores para la monitorización continua del impacto de programas de optimización de uso de antimicrobianos en Atención Primaria. Enferm Infecc Microbiol Clin 2015; 33:311-9. [DOI: 10.1016/j.eimc.2014.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 07/16/2014] [Accepted: 07/18/2014] [Indexed: 11/23/2022]
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Suthar JV, Patel VJ, Vaishnav B. Quality of prescribing for hypertension and bronchial asthma at a tertiary health care facility, India using Prescription Quality Index tool. J Basic Clin Pharm 2014; 6:1-6. [PMID: 25538464 PMCID: PMC4268623 DOI: 10.4103/0976-0105.145759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Several tools have been introduced to evaluate the quality of prescribing. The aim of this study was to determine the quality of prescribing in hypertension and bronchial asthma in tertiary health care (THC) setting using the new Prescription Quality Index (PQI) tool and to assess the reliability of this tool. METHODS A prospective cross-sectional study was carried out for 2 months in order to assess the quality of prescribing of antihypertensive and antiasthmatic drugs using recently described PQI at THC facility. Patients with hypertension and bronchial asthma, attending out-patient departments of internal medicine and pulmonary medicine respectively for at least 3 months were included. Complete medical history and prescriptions received were noted. Total and criteria wise PQI scores were derived for each prescription. Prescriptions were categorized as poor, medium and high quality based on total PQI scores. RESULTS A total of 222 patients were included. Mean age was 56 ± 15.1 years (range 4-87 years) with 67 (30.2%) patients above 65 years of age. Mean total PQI score was 32.1 ± 5.1. Of 222 prescriptions, 103 (46.4%) prescriptions were of high quality with PQI score ≥34. Quality of prescribing did not differ between hypertension and bronchial asthma (P > 0.05). The value of Cronbach's α for the entire 22 criteria of PQI was 0.71. CONCLUSION As evaluated by PQI tool, the quality of prescribing for hypertension and bronchial asthma is good in about 47% of prescriptions at THC facility. PQI is valid for measuring prescribing quality in these chronic diseases in Indian setting.
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Affiliation(s)
- Jalpa V Suthar
- Department of Pharmacology, Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology, Changa, Gujarat, India
| | - Varsha J Patel
- Department of Pharmacology, NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - B Vaishnav
- Department of Medicine, Shree Krishna Hospital, Karamsad, Gujarat, India
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Campbell SM, Godman B, Diogene E, Fürst J, Gustafsson LL, MacBride-Stewart S, Malmström RE, Pedersen H, Selke G, Vlahović-Palčevski V, van Woerkom M, Wong-Rieger D, Wettermark B. Quality indicators as a tool in improving the introduction of new medicines. Basic Clin Pharmacol Toxicol 2014; 116:146-57. [PMID: 25052464 DOI: 10.1111/bcpt.12295] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/07/2014] [Indexed: 01/18/2023]
Abstract
Quality indicators are increasingly used as a tool to achieve safe and quality clinical care, cost-effective therapy, for professional learning, remuneration, accreditation and financial incentives. A substantial number focus on drug therapy but few address the introduction of new medicines even though this is a burning issue. The objective was to describe the issues and challenges in designing and implementing a transparent indicator framework and evaluation protocol for the introduction of new medicines and to provide guidance on how to apply quality indicators in the managed entry of new medicines. Quality indicators need to be developed early to assess whether new medicines are introduced appropriately. A number of key factors need to be addressed when developing, applying and evaluating indicators including dimensions of quality, suggested testing protocols, potential data sources, key implementation factors such as intended and unintended consequences, budget impact and cost-effectiveness, assuring the involvement of the medical professions, patients and the public, and reliable and easy-to-use computerized tools for data collection and management. Transparent approaches include the need for any quality indicators developed to handle conflict of interests to enhance their validity and acceptance. The suggested framework and indicator testing protocol may be useful in assessing the applicability of indicators for new medicines and may be adapted to healthcare settings worldwide. The suggestions build on existing literature to create a field testing methodology that can be used to produce country-specific quality indicators for new medicines as well as a cross international approach to facilitate access to new medicines.
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Affiliation(s)
- Stephen M Campbell
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK; NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health, University of Manchester, Manchester, UK
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15
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Maio S, Baldacci S, Martini F, Cerrai S, Sarno G, Borbotti M, Pala AP, Murgia N, Viegi G. COPD management according to old and new GOLD guidelines: an observational study with Italian general practitioners. Curr Med Res Opin 2014; 30:1033-42. [PMID: 24450467 DOI: 10.1185/03007995.2014.884492] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Guideline recommendations for COPD management are only partially applied within primary care clinical practice. OBJECTIVE To compare the COPD management by Italian general practitioners (GPs) according to either the old GOLD (oGOLD) or the new GOLD (nGOLD) guidelines. RESEARCH DESIGN AND METHODS Observational study in different Italian areas. A total of 176 GPs enrolled their patients with a COPD diagnosis. Questionnaires were used to collect data on: COPD symptoms, disease severity, exacerbations, prescribed pharmacological and non-pharmacological treatments. COPD severity was estimated according to oGOLD and nGOLD guidelines. RESULTS A total of 526 subjects had complete information to assess COPD severity level according to guidelines (symptoms level, spirometry, history of exacerbations). The investigated subjects were more frequently males (71.2%) with a mean age of 72.5 years, and ex-smokers (44.4%). GPs reported sufficient control of the disease in 47.2% of the subjects with over two exacerbations in the last 12 months. Most patients have moderate COPD (51.5%), according to oGOLD, and belong to D groups (high risk, more symptoms) (45.6%), according to nGOLD. Overall, a low use of post-bronchodilator spirometry (65.1%) and of pulmonary rehabilitation (13.4%) was shown. The results highlighted a low prescriptive appropriateness but with higher value according to nGOLD than oGOLD: 61.4% vs 35.6%. STUDY LIMITATIONS Prescription data only provide limited information to judge prescribing quality, thus the results have to be evaluated with caution; moreover, this study was not designed to assess the difference between oGOLD and nGOLD. CONCLUSIONS Guideline recommendations are applied only partially within clinical practice. A higher prescriptive appropriateness is shown by GPs using nGOLD classification. This might be due to the fact that nGOLD, with respect to oGOLD, takes into account anamnestic usual features considered by GPs in their clinical practice.
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Affiliation(s)
- S Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology , Pisa , Italy
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16
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Adriaenssens N, Bartholomeeusen S, Ryckebosch P, Coenen S. Quality of antibiotic prescription during office hours and out-of-hours in Flemish primary care, using European quality indicators. Eur J Gen Pract 2013; 20:114-20. [PMID: 23998298 DOI: 10.3109/13814788.2013.828200] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND European disease-specific antibiotic prescribing quality indicators (APQI) were proposed for seven acute indications (bronchitis, upper respiratory infection, cystitis, tonsillitis, sinusitis, otitis media and pneumonia): (a) the percentage of patients prescribed an antibiotic; (b) the percentage of patients receiving the guideline recommended antibiotic; (c) the percentage of patients receiving quinolones. OBJECTIVES To assess the feasibility of calculating values for these 21 APQI using primary care databases; and to assess the quality of antibiotic prescribing in office hours and out-of-hours general practice. METHODS Data was extracted from a morbidity registration network ( http://www.intego.be ) and the out-of-hours service centre in Flanders. Within both databases diagnoses are labelled using the revised second edition of International Classification of Primary Care (ICPC-2-R) and antibiotic prescriptions using Anatomical Therapeutic Chemical (ATC) classification. RESULTS Both databases allow calculation of APQI values and results are similar. Only for cystitis was the percentage of patients prescribed an antibiotic within the proposed acceptable range. For all indications, the percentage of recommended antibiotics was below the proposed acceptable range (80-100%). The percentage of quinolones was within the proposed acceptable range (0-5%) for otitis media, upper respiratory infection and tonsillitis. CONCLUSION Primary care databases can produce APQI values. These values revealed huge opportunities to improve the quality of antibiotic prescribing in office hours and out-of-hours Flemish general practice, especially the prescription of recommended antibiotics.
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Affiliation(s)
- Niels Adriaenssens
- University of Antwerp, Vaccine & Infectious Disease Institute (VAXINFECTIO), Centre for General Practice , Antwerp , Belgium
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17
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Fernández-Urrusuno R, Flores-Dorado M, Vilches-Arenas A, Serrano-Martino C, Corral-Baena S, Montero-Balosa MC. [Appropriateness of antibiotic prescribing in a primary care area: a cross-sectional study]. Enferm Infecc Microbiol Clin 2013; 32:285-92. [PMID: 23867142 DOI: 10.1016/j.eimc.2013.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/07/2013] [Accepted: 05/15/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the profile of patients receiving antibiotics and the appropriateness of these prescriptions for the clinical conditions. METHODS DESIGN Cross-sectional study of prescription-indication. SETTING A primary health care area in Andalusia. SUBJECTS Patients assigned to primary care centres. Patients with antibiotic prescriptions during 2009 were selected by simple random sampling (confidence level: 95%, accuracy: 5%). Primary endpoint: appropriateness of antibiotics prescribing to recommendations included in local guidelines. Data were obtained through the billing computerised prescriptions system and medical histories. RESULTS Twenty-five per cent of the population area received antibiotics during 2009. The 1,266 patient samples showed the following characteristics: 57.9% were women, with a mean age of 41 (±1) years. There were 39.3% pensioners. The percentage of appropriate antibiotic prescriptions was 19.9%, with no difference due to gender. Statistically significant differences were related to age, being those over 65 years the group of patients with the highest percentage of inappropriateness. The main reasons for inappropriateness were: no recording of the infectious process (44.5%), a wrong treatment duration (15.5%), and the use of an inadequate antibiotic (11.5%). CONCLUSION There is a high level of inappropriateness in antibiotic prescribing in primary care. The high level of under-recording of diagnoses, mainly in elderly patients, followed by the use of wrong schedules, and the wrong type of antibiotics were the main reasons of inappropriateness.
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Affiliation(s)
| | | | | | - Carmen Serrano-Martino
- Laboratorio de Microbiología, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - Susana Corral-Baena
- Servicio de Farmacia, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
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Fernández Urrusuno R, Montero Balosa MC, Pérez Pérez P, Pascual de la Pisa B. Compliance with quality prescribing indicators in terms of their relationship to financial incentives. Eur J Clin Pharmacol 2013; 69:1845-53. [PMID: 23743780 DOI: 10.1007/s00228-013-1542-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 05/21/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Rocío Fernández Urrusuno
- Service of Pharmacy, Aljarafe-Sevilla Norte Primary Health Care Area, Distrito Sanitario Aljarafe; Avda de las Américas s/n, 41927, Mairena del Aljarafe, Seville, Spain,
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Graabaek T, Kjeldsen LJ. Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes: a systematic review. Basic Clin Pharmacol Toxicol 2013; 112:359-73. [PMID: 23506448 DOI: 10.1111/bcpt.12062] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/14/2013] [Indexed: 11/29/2022]
Abstract
Suboptimal medication use may lead to morbidity, mortality and increased costs. To reduce unnecessary patient harm, medicines management including medication reviews can be provided by clinical pharmacists. Some recent studies have indicated a positive effect of this service, but the quality and outcomes vary among studies. Hence, there is a need for compiling the evidence within this area. The aim of this systematic MiniReview was to identify, assess and summarize the literature investigating the effect of pharmacist-led medication reviews in hospitalized patients. Five databases (MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library) were searched from their inception to 2011 in addition to citation tracking and hand search. Only original research papers published in English describing pharmacist-led medication reviews in a hospital setting including minimum 100 patients or 100 interventions were included in the final assessment. A total of 836 research papers were identified, and 31 publications were included in the study: 21 descriptive studies and 10 controlled studies, of which 6 were randomized controlled trials. The pharmacist interventions were well implemented with acceptance rates from 39% to 100%. The 10 controlled studies generally show a positive effect on medication use and costs, satisfaction with the service and positive as well as insignificant effects on health service use. Several outcomes were statistically insignificant, but these were predominantly associated with low sample sizes or low acceptance rates. Therefore, future research within this area should be designed using rigorous design, large sample sizes and includes comparable outcome measures for patient health outcomes.
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Affiliation(s)
- Trine Graabaek
- Department of Quality, Hospital South West Jutland, Esbjerg, Denmark.
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20
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Maio S, Simoni M, Baldacci S, Angino A, Martini F, Cerrai S, Sarno G, Silvi P, Borbotti M, Pala AP, Bresciani M, Paggiaro PL, Viegi G. The ARGA study with Italian general practitioners: prescriptions for allergic rhinitis and adherence to ARIA guidelines. Curr Med Res Opin 2012; 28:1743-51. [PMID: 22958052 DOI: 10.1185/03007995.2012.724393] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND General practitioners (GPs) are the healthcare professionals to whom patients with rhinitis firstly refer for their symptoms. OBJECTIVE In the present study, we assessed drug prescriptions for allergic rhinitis (AR) and evaluated prescriptive adherence to ARIA treatment guidelines. METHODS Data on 1379 AR patients were collected by 107 Italian GPs. Adherence to ARIA guidelines was evaluated according to AR severity classification. RESULTS AR was diagnosed by GPs as mild intermittent for 46.2% of patients, mild persistent for 26.6%, moderate-severe intermittent for 20.2%, and moderate-severe persistent for 7%; 43.7% of AR patients had concomitant asthma. The most frequently prescribed therapeutic groups were antihistamines (anti-H, 76%) and nasal corticosteroids (NCS, 46%). Anti-H were significantly used more often to treat AR alone than AR + asthma (85 vs. 68%, p < 0.001), whereas NCS were used more often to treat AR + asthma than AR alone (50 vs. 42%, p = 0.01). Among patients with only mild intermittent AR, 39% were prescribed combined therapy. Among patients with moderate-severe persistent AR, 30% of those with AR alone and 18% of those with AR + asthma were prescribed monotherapy based on anti-H. GPs were more compliant with ARIA guidelines while treating AR alone (57%) than AR + asthma (46%) patients. The adherence increased according to the severity grade and was satisfactory for moderate-severe persistent AR (89% for AR alone and 95% for AR + asthma). CONCLUSIONS Adherence to ARIA guidelines is satisfactory only for treatment of more severe patients, thus GPs often tend to treat patients independently from ARIA guidelines. Since prescription data only provide limited information to judge prescribing quality, some deviation from the gold standard are to be expected.
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Affiliation(s)
- S Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.
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Lépée C, Klaber RE, Benn J, Fletcher PJ, Cortoos PJ, Jacklin A, Franklin BD. The use of a consultant-led ward round checklist to improve paediatric prescribing: an interrupted time series study. Eur J Pediatr 2012; 171:1239-45. [PMID: 22628136 DOI: 10.1007/s00431-012-1751-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/02/2012] [Indexed: 11/28/2022]
Abstract
UNLABELLED A Check and Correct checklist has previously been developed to increase feedback on prescribing quality and enhance physicians' focus on patients' drug charts during ward rounds. Our objective was to assess the impact of introducing such a prescribing checklist on the quality and safety of inpatient prescribing in two paediatric wards in a London teaching hospital. Between 15 March 2011 and 15 May 2011 (pre-intervention) and between 23 May 2011 and 23 July 2011 (post-intervention), we recorded rates of both technical prescription writing errors and clinical prescribing errors twice a week. During the pre-intervention period, the overall technical error rate was 10.8 % (95 % confidence interval 10.3 %-11.2 %); the clinical error rate was 4.7 % (3.4 %-6.6 %). The most common errors were absence of prescriber's contact details and dose omissions. After the implementation of Check and Correct, error rates were 7.3 % (6.9 %-7.8 %) and 5.5 % (3.9 %-7.9 %), respectively. Segmented regression analysis revealed a significant decrease of -5.0 % in the technical error rate (-7.1 to -2.9 %; -37.7 % relative decrease; R (2) = 0.604) following the intervention, independent of changes in overall medical records' documentation quality. Regarding clinical errors, no significant impact of the intervention could be detected. CONCLUSION Implementing a Check and Correct checklist led to an improvement in the quality of prescription writing. Although a change in culture may be needed to maximise its potential, we would recommend its more widespread use and evaluation.
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Affiliation(s)
- Carole Lépée
- Sciences du Risque dans le domaine de la Santé, Faculté de Pharmacie, Université d'Auvergne, Clermont-Ferrand, France
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Baldacci S, Maio S, Simoni M, Cerrai S, Sarno G, Silvi P, Di Pede F, Borbotti M, Pala AP, Bresciani M, Viegi G. The ARGA study with general practitioners: impact of medical education on asthma/rhinitis management. Respir Med 2012; 106:777-85. [PMID: 22436656 DOI: 10.1016/j.rmed.2012.02.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/26/2012] [Accepted: 02/21/2012] [Indexed: 11/20/2022]
Abstract
AIM To evaluate the impact of a medical education course (MEC) on the behaviour of general practitioners (GPs) to treat asthma and allergic rhinitis (AR). METHODS Data on 1820 patients (mean age 41 yrs ± 17 yrs) with asthma or AR were collected by 107 Italian GPs: 50% attended a MEC and 50% didn't (group B). The adherence for AR and asthma treatment was evaluated according to ARIA and GINA guidelines (GL). RESULTS AR and asthma were diagnosed in 78% and 56% of patients; 34% had concomitant AR and asthma. Regardless of the MEC, the adherence to GL was significantly higher for AR than for asthma treatment (52 versus 19%). Group B GPs were more compliant to ARIA guidelines in the treatment of mild AR, whereas group A were more compliant in the treatment of moderate-severe AR; the adherence didn't differ between the groups for AR patients with comorbid asthma. Adherence to GINA GL for asthma treatment did not differ between GPs of groups A and B, independently from concomitant AR. Though insignificantly, group A were more compliant to GINA GL in the treatment of patients with only severe persistent asthma (63 versus 46%) as group B were for patients with severe persistent asthma and concomitant AR. CONCLUSIONS GPs often tend to treat patients independently from GL. The impact of a single MEC did not improve adherence to GL in treating less severe AR and asthma patients, while there was a trend towards the opposite attitude in more severe AR patients without concomitant asthma.
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Affiliation(s)
- Sandra Baldacci
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Via Trieste, 41 - 56126 Pisa, Italy.
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The regional profile of antibiotic prescriptions in Italian outpatient children. Eur J Clin Pharmacol 2012; 68:997-1005. [PMID: 22271296 DOI: 10.1007/s00228-011-1204-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 12/21/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To evaluate paediatric antibiotic prescription patterns in Italy in an extra-hospital setting at the national, regional, and Local Health Unit (LHU) level. METHODS Data sources were regional prescription databases. Eight Italian regions participated in the study providing data for the year 2008, with two exceptions (where the data for 2009 and 2006 were provided instead). A total of 4,828,569 children were included: 58% of the Italian population under 15 years old. Antibiotic prevalence rates, prescription rates and prescriptions distribution by class were evaluated at the regional and LHU levels. The correlation among mean latitude, Human Development Index (HDI), hospitalisation rate, satisfaction index for the National Health Service, number of paediatricians per 1,000 resident children and prevalence rate was evaluated by regions. RESULTS The estimated pooled average prevalence rate was 50.5% (95%CI 45.7-55.3). Between-regions prevalence rates ranged from 42.6% to 62.1% and at the LHU level they ranged from 35.6% to 68.5%. There was a trend indicating that in southern regions antibiotics are more frequently prescribed than in the northern and central regions (Cochrane-Armitage test Z = -187.5 p < 0.0001). Overall, penicillin covered 53.1% of antibiotic prescriptions, with differences between regions ranging from 39.2% to 62.5%. A direct correlation was found between the prevalence rate and HDI (p = 0.031), while an inverse correlation was found with paediatricians per 1,000 resident children (p = 0.038). CONCLUSIONS We found that relevant differences exist between the northern and the southern part of the country, and the heterogeneity among LHUs is higher. The greater use of antibiotics in the southern regions is related to lower HDI and does not seems to be justified by the higher prevalence of infectious diseases.
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Davidsen JR, Hallas J, Søndergaard J, Christensen RD, Siersted HC, Hansen MP, Knudsen TB, Lykkegaard J, Andersen M. Association between prescribing patterns of anti-asthmatic drugs and clinically uncontrolled asthma: a cross-sectional study. Pulm Pharmacol Ther 2011; 24:647-53. [PMID: 21946053 DOI: 10.1016/j.pupt.2011.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 08/11/2011] [Accepted: 09/09/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Studies based on prescription data have shown that many asthmatics tend to use large quantities of inhaled beta-2-agonists, suggesting poorly controlled disease. The aim of the present study was to investigate the association between clinically uncontrolled asthma and prescribing patterns of anti-asthmatic drugs with a primary focus on short-acting beta-2-agonists (SABA). METHODS In a cross-sectional study 357 subjects, selected by their prescriptions of inhaled beta-2-agonists in Odense Pharmaco-Epidemiological Database, underwent individual clinical assessment including the Asthma Control Questionnaire (ACQ) and spirometry. The associations between uncontrolled asthma (ACQ score ≥ 1.50) and individual anti-asthmatic prescribing were analysed by means of logistic regression. RESULTS Clinically uncontrolled asthma was positively associated with SABA use, the association becoming stronger with higher annual quantity of SABA use, odds ratio (OR) 11.1 (95% CI 4.4-28.0) for ≥400 DDD/year. This trend persisted after stratifying for gender, age, and controller treatment. Although subjects using ≥450 DDD/year were all uncontrolled, there was substantial overlap in SABA use between controlled and uncontrolled subjects below this limit. We found no effect modification by age and gender. Use of inhaled corticosteroids protected against uncontrolled asthma, OR 0.51 (95% CI 0.27-0.95). CONCLUSION Asthmatics with a high use of SABA frequently have problems with uncontrolled asthma, and users of ICS are protected against uncontrolled asthma. The associations we found were, however, to weak too allow firm conclusions about asthma control for most individual asthma patients.
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Affiliation(s)
- Jesper Rømhild Davidsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark.
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Sipilä R, Helin-Salmivaara A, Korhonen MJ, Ketola E. Change in antihypertensive drug prescribing after guideline implementation: a controlled before and after study. BMC FAMILY PRACTICE 2011; 12:87. [PMID: 21849037 PMCID: PMC3176159 DOI: 10.1186/1471-2296-12-87] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 08/17/2011] [Indexed: 11/30/2022]
Abstract
Background Antihypertensive drug choices and treatment levels are not in accordance with the existing guidelines. We aimed to assess the impact of a guideline implementation intervention on antihypertensive drug prescribing. Methods In this controlled before and after study, the effects of a multifaceted (education, audit and feedback, local care pathway) quality programme was evaluated. The intervention was carried out in a health centre between 2002 and 2003. From each health care unit (n = 31), a doctor-nurse pair was trained to act as peer facilitators in the intervention. All antihypertensive drugs prescribed by 25 facilitator general practitioners (intervention GPs) and 53 control GPs were retrieved from the nationwide Prescription Register for three-month periods in 2001 and 2003. The proportions of patients receiving specific antihypertensive drugs and multiple antihypertensive drugs were measured before and after the intervention for three subgroups of hypertension patients: hypertension only, with coronary heart disease, and with diabetes. Results In all subgroups, the use of multiple concurrent medications increased. For intervention patients with hypertension only, the odds ratio (OR) was 1.12 (95% CI 0.99, 1.25; p = 0.06) and for controls 1.13 (1.05, 1.21; p = 0.002). We observed no statistically significant differences in the change in the prescribing of specific antihypertensive agents between the intervention and control groups. The use of agents acting on the renin-angiotensin-aldosterone system increased in all subgroups (hypertension only intervention patients OR 1.19 (1.06, 1.34; p = 0.004) and controls OR 1.24 (1.15, 1.34; p < 0.0001). Conclusions A multifaceted guideline implementation intervention does not necessarily lead to significant changes in prescribing performance. Rigorous planning of the interventions and quality projects and their evaluation are essential.
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Affiliation(s)
- Raija Sipilä
- Current Care, Finnish Medical Society Duodecim, Helsinki.
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Urrusuno RF, de la Pisa BP, Balosa MM. Impact of postal prescriber feedback on prescribing practice of Andalucian primary care paediatricians. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2011. [DOI: 10.1111/j.1759-8893.2011.00047.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Urrusuno RF, Balosa MCM, de la Pisa BP, Mateos SJ, Calvo CB. Developing indicators of prescribing quality for primary care paediatricians. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2010. [DOI: 10.1111/j.1759-8893.2010.00031.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Boesten J, Harings L, Winkens B, Knottnerus A, van der Weijden T. Defining antimicrobial prescribing quality indicators: what is a new prescription? Eur J Clin Pharmacol 2010; 67:91-6. [PMID: 20941487 PMCID: PMC3016215 DOI: 10.1007/s00228-010-0909-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 09/21/2010] [Indexed: 11/28/2022]
Abstract
Since guidelines on antibiotic drug treatment often focus on appropriate first choice drugs, assessment of guideline adherence should only concentrate on the first drug prescribed, and not on subsequent antibiotics prescribed after failure of the first one. Purpose To determine a valid cut-off point for a definition of “first” or “new” prescription in indicators for the assessment of the quality of antibiotic drug treatment on the basis of pharmaceutical data. Methods Three possible definitions for the term “new prescription” were compared, based on three different periods of time, viz. more than 35, 28, or 21 days after starting a previous antibiotic. In an observational study, 1,225 antimicrobial prescriptions from the medical files of five family practices were audited (“clinical classification”) and compared with a classification based on the three definitions (“technical classification”). Agreement between these clinical and technical classifications was determined by calculating Cohen’s kappa. The technical classification was analyzed as a diagnostic test, using the clinical classification as the gold standard, and sensitivity, specificity, likelihood ratios, and post-test probabilities were calculated. Results Defining “new prescription” as “more than 35 days after a previous prescription was issued” resulted in a Cohen’s kappa of 0.93 (95% CI 0.92–0.98). The diagnostic value of this definition was extremely high, with a sensitivity of 0.976, specificity of 0.987, positive likelihood ratio of 77.7, and negative likelihood ratio of 0.02. Conclusion We recommend using a cut-off value of 35 days since the last antimicrobial prescription as the definition of a “new prescription” when no diagnostic information is available, i.e., when using pharmaceutical data to assess the quality of antibiotic prescribing behavior.
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Affiliation(s)
- Jos Boesten
- Department of General Practice, CAPHRI, School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Fröhlich SE, Zaccolo AV, da Silva SLC, Mengue SS. Association between drug prescribing and quality of life in primary care. ACTA ACUST UNITED AC 2010; 32:744-51. [DOI: 10.1007/s11096-010-9431-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Accepted: 08/09/2010] [Indexed: 12/21/2022]
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Niquille A, Ruggli M, Buchmann M, Jordan D, Bugnon O. The nine-year sustained cost-containment impact of swiss pilot physicians-pharmacists quality circles. Ann Pharmacother 2010; 44:650-7. [PMID: 20215496 DOI: 10.1345/aph.1m537] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Six pioneer physicians-pharmacists quality circles (PPQCs) located in the Swiss canton of Fribourg (administratively corresponding to a state in the US) were under the responsibility of 6 trained community pharmacists moderating the prescribing process of 24 general practitioners (GPs). PPQCs are based on a multifaceted collaborative process mediated by community pharmacists for improving compliance with clinical guidelines within GPs' prescribing practices. OBJECTIVE To assess, over a 9-year period (1999-2007), the cost-containment impact of the PPQCs. METHODS The key elements of PPQCs are a structured continuous quality improvement and education process; local networking; feedback of comparative and detailed data regarding costs, drug choice, and frequency of prescribed drugs; and structured independent literature review for interdisciplinary continuing education. The data are issued from the community pharmacy invoices to the health insurance companies. The study analyzed the cost-containment impact of the PPQCs in comparison with GPs working in similar conditions of care without particular collaboration with pharmacists, the percentage of generic prescriptions for specific cardiovascular drug classes, and the percentage of drug costs or units prescribed for specific cardiovascular drugs. RESULTS For the 9-year period, there was a 42% decrease in the drug costs in the PPQC group as compared to the control group, representing a $225,000 (USD) savings per GP only in 2007. These results are explained by better compliance with clinical and pharmacovigilance guidelines, larger distribution of generic drugs, a more balanced attitude toward marketing strategies, and interdisciplinary continuing education on the rational use of drugs. CONCLUSIONS The PPQC work process has yielded sustainable results, such as significant cost savings, higher penetration of generics and reflection on patient safety, and the place of "new" drugs in therapy. The PPQCs may also constitute a solid basis for implementing more comprehensive collaborative programs, such as medication reviews, adherence-enhancing interventions, or disease management approaches.
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A study on utilization of anti–asthmatic drugs at a medical college hospital in India. ASIAN PAC J TROP MED 2010. [DOI: 10.1016/s1995-7645(10)60037-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Lesén E, Petzold M, Andersson K, Carlsten A. To what extent does the indicator “concurrent use of three or more psychotropic drugs” capture use of potentially inappropriate psychotropics among the elderly? Eur J Clin Pharmacol 2009; 65:635-42. [DOI: 10.1007/s00228-009-0623-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 01/13/2009] [Indexed: 11/24/2022]
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Voorham J, Denig P. Computerized extraction of information on the quality of diabetes care from free text in electronic patient records of general practitioners. J Am Med Inform Assoc 2007; 14:349-54. [PMID: 17329733 PMCID: PMC2244890 DOI: 10.1197/jamia.m2128] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study evaluated a computerized method for extracting numeric clinical measurements related to diabetes care from free text in electronic patient records (EPR) of general practitioners. DESIGN AND MEASUREMENTS Accuracy of this number-oriented approach was compared to manual chart abstraction. Audits measured performance in clinical practice for two commonly used electronic record systems. RESULTS Numeric measurements embedded within free text of the EPRs constituted 80% of relevant measurements. For 11 of 13 clinical measurements, the study extraction method was 94%-100% sensitive with a positive predictive value (PPV) of 85%-100%. Post-processing increased sensitivity several points and improved PPV to 100%. Application in clinical practice involved processing times averaging 7.8 minutes per 100 patients to extract all relevant data. CONCLUSION The study method converted numeric clinical information to structured data with high accuracy, and enabled research and quality of care assessments for practices lacking structured data entry.
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Affiliation(s)
- Jaco Voorham
- Sector F, Department of Clinical Pharmacology, Groningen, The Netherlands.
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