Developing indicators of prescribing quality for primary care paediatricians

Abstract

Monitoring and feedback to physicians on their prescribing patterns helps to promote change in the areas where it is needed. However, behaviour and satisfaction of general paediatricians with the routine monitoring of their prescribing has not been measured. We aimed to develop a set of valid indicators of prescribing quality in paediatric primary care practice, and to evaluate the satisfaction of paediatricians with such indicators. Prescribing indicators were chosen by consensus-group technique. All paediatricians in the Primary Health Care Area, where the study took place, received feedback with indicators within 1 year. The face validity of these indicators was assessed by collecting data from anonymous questionnaires sent to the paediatricians issuing prescriptions. Twelve prescribing indicators were identified to be appropriate for assessing the quality of therapeutic management in common illness in children in primary care. Consensus was reached on four indicators suitable for application to continuous monitoring. They focused on the relative use of broad- and narrow-spectrum antibiotics, the relative use of inhaled beta-agonists and inhaled steroids and the relative use of inhaled steroids compared with leukotriene antagonists. Thirty-seven paediatricians (93%) filled out the questionnaire. Antibiotic indicators were well accepted by 92% of them. Fifty-four per cent of paediatricians thought that the proposed asthma indicators do not reflect prescribing quality for this disease. Indicators assessing prescribing quality by primary care paediatricians should be based on anti-asthmatics and antibiotics. Periodic feedback with these indicators increases professional satisfaction and contributes to improved drug selection in the opinion of paediatricians. Opinion was divided on the use of such indicators with respect to the distribution of financial incentives.