Adherence Barriers to Antimicrobial Treatment Guidelines in Teaching Hospital, the Netherlands

To optimize appropriate antimicrobial use in a university hospital and identify barriers hampering implementation strategies, physicians were interviewed regarding their opinions on antimicrobial policies. Results indicated that effective strategies should include regular updates of guidelines that incorporate the views of relevant departments and focus on addressing senior staff and residents because residents do not make independent decisions in a teaching-hospital setting

Validity of performance indicators for assessing prescribing quality : the case of asthma

OBJECTIVES: The aim of this study was to assess the concurrent validity between the identification of sub-optimal treatment based on clinical information and computer generated indicators. Indicators that are associated with sub-optimal treatment in one of the four steps of asthma management were assessed. DESIGN: The ability of each indicator to identify patients with sub-optimal asthma treatment from computerised general practitioner (GP) prescription records was assessed by comparing them with the results of an individual patient assessment using clinical data. SETTING: Chronic asthma patients (n=146) registered with 16 Dutch GPs. MAIN MEASURES: The sensitivity and positive predictive value (PPV) of each performance indicator was determined. RESULTS: The step-1 indicator, focusing on patients not prescribed a short-acting beta-agonist, had an acceptable sensitivity (0.86), but a low PPV (0.52). The two step-2 indicators, targeting under-prescription of inhaled corticosteroids, had sensitivities of 0.74 and 0.37 and PPVs of 0.46 and 0.71, respectively. The step-3 indicator, which targeted under-dosing of inhaled corticosteroids, had a sensitivity of 0.07 and a PPV of 0.2. The fourth indicator, focusing on under-prescription of long-acting beta-agonists, could not be validated due to inadequate numbers of patients with severe asthma in our study sample. DISCUSSION: None of the indicators investigated was considered valid for assessing prescriber performance, despite having good face and content validity. Performance indicators that have not been validated can only provide a broad-brush approach for assessing prescribing quality and should be used with extreme caution.8 page(s

Determinants for the adoption of angiotensin II receptor blockers by general practitioners

Results of studies conducted 10-20 years ago show the prominence of commercial information sources in the adoption process of new drugs. Over the past decade, there has been a growing emphasis on practicing evidence-based medicine in drug prescribing. This raises the question whether professional information sources currently counterbalance the influence of commercial information sources in the adoption process. The aim of this study was to identify determinants influencing the adoption of a new drug class, the angiotensin II receptor blockers (ARBs), by general practitioners (GPs) in The Netherlands. A retrospective study was conducted to assess prevalent ARB prescribing for hypertensive patients using the Integrated Primary Care Information (IPCI) database. We conducted a survey among all GPs who participated in the IPCI project in 2003 to assess their exposure to commercial and professional information sources, perceived benefits and risks of ARBs, perceived influences of the professional network, and general characteristics. Multilevel logistic regression was applied to identify determinants of ARB adoption while adjusting for patient characteristics. Data were obtained from 70 GPs and 9470 treated hypertensive patients. A total of 1093 patients received ARBs (12%). GPs who reported frequent use of commercial information sources were more likely to prescribe ARBs routinely in preference to other antihypertensives, whereas GPs who used a prescribing decision support system and those who were involved in pharmacotherapy education were less likely to prescribe ARBs. Other factors that were associated with higher levels of ARB adoption included a more positive perception of ARBs regarding their effectiveness in lowering blood pressure, and working in single-handed practices or in rural areas. Aside from determinants related to the patient population, adoption of a new drug class among Dutch GPs is still determined more by their reliance on promotional information than by their use of professional information sources.The Netherlands Angiotensin II receptor blockers Antihypertensive treatment Decision making Drug utilization Primary care

PHARMACOEPIDEMIOLOGY AND PRESCRIPTION Uptake of angiotensin II receptor blockers in the treatment of hypertension

Citation for published version (APA): Greving, JP., Denig, P., van der Veen, WJ., Beltman, FW., Sturkenboom, MCJM., de Zeeuw, D., & HaaijerRuskamp, FM. (2005). Uptake of angiotensin II receptor blockers in the treatment of hypertension. European Journal of Clinical Pharmacology, 61(5-6), 461-466. https://doi.org/10.1007/s00228-005-0924-7 Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). 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. Abstract Objective: To examine trends in prescribing of angiotensin II receptor blockers (ARBs) as initial and second-line treatment of hypertension. Methods: We performed a cohort study in the Integrated Primary Care Information database, a general practice research database in The Netherlands. We included hypertensive patients who were newly treated with antihypertensive drugs between 1996 and 1999. Initial treatment was defined as the first prescribed antihypertensive drug after diagnosis of hypertension. As secondline treatment, we considered prescriptions of a second antihypertensive drug class, either as switch or addition. We used logistic regression and Cox proportional hazard analysis to estimate time trends in use of ARBs as initial or second-line treatment. Results: In total, 8% of the 3,102 newly treated hypertensive patients received ARBs as initial treatment. Initial ARB use increased significantly from 4% to 10% during the period 1996-1999, whereas calcium channel blocker and angiotensin-converting enzyme inhibitor (ACE-I) use decreased. ARBs were used as second-line treatment in less than 4% of 2,544 patients who were initially treated with an antihypertensive drug other than an ARB: 2% switched to an ARB (mostly from ACE-Is) and 1% received ARBs as add-on treatment. Diuretics and beta-blockers were used five to ten times more often as add-on treatment than ARBs. Conclusion: ARBs achieved a position in the treatment of hypertension as initial rather than second-line therapy