Heart failure guidelines and prescribing in primary care across Europe

BACKGROUND: Major international differences in heart failure treatment have been repeatedly described, but the reasons for these differences remain unclear. National guideline recommendations might be a relevant factor. This study, therefore, explored variation of heart failure guideline recommendations in Europe. METHODS: Treatment recommendations of 14 national guidelines published after 1994 were analyzed in relation to the heart failure treatment guideline of the European Society of Cardiology. To test potential relations between recommendations and prescribing, national prescribing patterns as obtained by a European study in primary care (IMPROVEMENT-HF) were related to selected recommendations in those countries. RESULTS: Besides the 14 national guidelines used by primary care physicians in the countries contacted, the European guideline was used in four countries, and separate guidelines for specialists and primary care were available in another four countries. Two countries indicated that no guideline was used up to 2000. Comprehensiveness of the guidelines varied with respect to length, literature included and evidence ratings. Relevant differences in treatment recommendations were seen only in drug classes where evidence had changed recently (β-blockers and spironolactone). The relation between recommendation and prescribing for selected recommendations was inconsistent among countries. CONCLUSION: Differences in guideline recommendations are not sufficient to explain variation of prescribing among countries, thus other factors must be considered

Indicators of quality use of medicines in South-East Asian countries: a systematic review

Indicators of quality use of medicines in South-East Asian countries Nguyen, H. T.; Wirtz, V. J.; Haaijer-Ruskamp, F. M.; Taxis, K. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Original studies or reports carried out in the South-East Asian region, explicitly using indicators to measure quality use of medicines, and published between January 2000 and July 2011 were included. results A total of 17 studies conducted in 7 of 11 countries in South-East Asia were included. WHO indicators focusing on general medication use in health facilities were most widely used (10 studies). Twelve studies used non-WHO indicators for measuring quality use of medicines in clinical areas (geriatrics and obstetrics) or specific diseases, such as diarrhoea and pneumonia. In five studies, WHO indicators were used along with non-WHO indicators. There was little information available about validity, reliability and feasibility of the non-WHO indicators. The majority of indicators measured process rather than structure or outcome. There were very few indicators addressing non-communicable diseases. conclusions A limited number of studies have been published explicitly using indicators of quality use of medicines across South-East Asia. Importantly, existing indicators need to be complemented with valid, reliable and feasible indicators related to non-communicable diseases, particularly those with a high financial burden to meet the current medical challenges in the region. keywords quality indicator, South-East Asi

Health care professionals' knowledge and attitudes of drug benefits and risks in africa

Background: Inappropriate drug use is a major global challenge. In Africa, it may be even more widespread for a number of reasons, especially limited resources. Drugs may be prescribed by health care professionals (HCPs) who have received little training on drug benefits, but especially risks. Objectives: Review knowledge and attitudes of HCPs on drug benefits and risks in Africa. Methods: We performed a systematic review in Embase.com selecting original studies that evaluated knowledge and attitudes of HCPs on modern or traditional medicines (drugs) in Africa following PRISMA guidelines. Results: We identified 71 papers studying HCP drug knowledge; most (68%) originated from 3 countries; i.e. Nigeria (29), South Africa (11) and Tanzania (8). Methods used were quantitative surveys in 45 papers; face-to-face interviews in 15, focus group discussions in 4 and mixed designs in 7. Physicians were studied in 24 (34%) papers, while 32 (42%) involved ≥2 types of HCPs. 32 (45%) papers were on communicable diseases (CD), 14 (20%) on non-communicable diseases (NCD) and 25 (35%) had no specific disease focus. A median of 120 (min 12; max 1440) HCPs were enrolled per study. Knowledge questions were answered correctly by >66% of HCPs in 15 (21%) papers, between 33 and 66% in 39 (55%) papers and b

Comparison of indicators assessing the quality of drug prescribing for asthma.

OBJECTIVE: To compare different indicators for assessing the quality of drug prescribing and establish their agreement in identifying doctors who may not adhere to treatment guidelines. DATA SOURCES/STUDY SETTING: Data from 181 general practitioners (GPs) from The Netherlands. The case of asthma is used as an example because, in this area, different quality indicators exist whose validity is questioned. The study is part of the European Drug Education Project. STUDY DESIGN: Spearman rank correlations were assessed among the GPs' scores on self-report instruments, aggregated prescribing indicators, and individualized prescribing indicators. Kappa values were calculated as agreement measures for identifying low adherence to the guidelines. DATA COLLECTION: Prescribing data from GPs were collected through pharmacies, public health insurance companies, or computerized GP databases. Two self-report instruments were mailed to the GPs. The GPs first received a questionnaire assessing their competence regarding the treatment of asthma patients. Three months later they received a series of 16 written asthma cases asking for their intended treatment for each case. PRINCIPAL FINDINGS: Correlations between scores based on self-report instruments and indicators based on actual prescribing data were mostly nonsignificant and varied between 0 and 0.21. GPs identified as not adhering to the guidelines by the prescribing indicators often had high scores on the self-report instruments. Correlations between 0.20 and 0.55 were observed among indicators based on aggregated prescribing data and those based on individualized data. The agreement for identifying low adherence was small, with kappa values ranging from 0.19 to 0.30. CONCLUSIONS: Indicators based on self-report instruments seem to overestimate guideline adherence. Indicators assessing prescribing quality at an aggregated level give clearly different results, as compared to indicators evaluating prescribing data on an individual patient level. Caution is needed when using such prescribing indicators to identify low adherence to guidelines. Further validation studies using a gold standard comparison are needed to define the best possible indicator

Begrippenkader voor het 'wat' en het 'waarom' bij implementatie van vernieuwingen in patiëntenzorg en preventie

Effectieve uitwisseling van ervaringen op het gebied van implementatie is gebaat bij standaardisering van het begrippenkader. Een projectgroep ontwikkelde een Nederlandstalig begrippenkader op basis van literatuurstudie en raadpleging van potentiële gebruikers. Het begrippenkader bestaat uit een korte typering van implementatiestrategieën (‘wat’) en beïnvloedende factoren bij implementatie (‘waarom’). Implementatiewerkers en -onderzoekers worden uitgenodigd dit begrippenkader te gebruiken bij de beschrijving van hun activiteiten. (aut. ref.

Prescribing quality indicators of type 2 diabetes mellitus ambulatory care

BACKGROUND: Existing performance indicators for assessing quality of care in type 2 diabetes mellitus (T2DM) focus mostly on registration of measurements and clinical outcomes, and not on quality of prescribing. OBJECTIVE: To develop a set of valid prescribing quality indicators (PQI) for internal use in T2DM, and assess the operational validity of the PQI using electronic medical records. METHODS: Potential PQI for hypertension, hyperglycaemia, dyslipidaemia and antiplatelet treatment in T2DM were based on clinical guidelines, and assessed on face and content validity in an expert panel followed by a panel of GPs and diabetologists. Analysis of ratings was performed using the RAND/UCLA Appropriateness Method. The operational validity of selected indicators was assessed in a dataset of 3214 T2DM patients registered with 70 GPs. RESULTS: Out of 31 potential prescribing indicators, the expert panel considered 18 indicators as sufficiently valid, of which 14 indicators remained valid after assessment by the panel of GPs and diabetologists. Of these 14 indicators, one could not be calculated because of an absence of eligible patients. For the remaining indicators, outcomes varied from 10% for timely prescribing of insulin to 96% for prescribing of any antihyperglycemic medication in patients with elevated HbA1c levels. CONCLUSIONS: This study provides a set of face- and content-valid PQI for pharmacological management of patients with T2DM. While outcomes of some PQI were limited to patients with registration of clinical values, the selected PQI had good operational validity to be used in practice for assessment of prescribing quality