Establishing quality prescribing indicators for Australian primary care: a Delphi study.

Abstract

Medication-related problems (MRPs) place a substantial burden on the healthcare system, contributing to hospital admissions and significant healthcare costs. Quality prescribing indicators (QPIs) offer a way to evaluate and guide improvements in prescribing with the aim of improving medicine use. This study aimed to establish an updated set of QPIs for Australian primary care. Potential QPIs were identified from a scoping review and reviewed by clinical members of the research team. Potential QPIs (n=37) that were identified to be relevant, feasible and impactful by the research team were assessed by an expert panel using a two-round Delphi consensus-building approach. The panel (n=42) included experienced general practitioners, pharmacists and nurse practitioners from urban/regional settings across Victoria, New South Wales and Tasmania. Each QPI's validity and importance were scored on a 5-point Likert scale. Participants could provide comments that were anonymously presented in round 2, along with other participants' scores. A QPI was approved if >80% of participants scored it a 4 or 5 for both validity and importance. A total of 23 of the 37 selected QPIs were approved, covering proton pump inhibitors, vaccinations, antihypertensives, anti-inflammatories, inhaled corticosteroids, mental health treatments and analgesics. The selected QPIs provide information on appropriate initiation, monitoring, deprescribing and the avoidance of high-risk prescribing. While mean scores and rate of acceptance were high, comments suggested perceived difficulties implementing some of the QPIs. QPIs for primary care were developed after a rigorous review and consensus process. These should be progressed to field testing and implementation. If integrated into routine primary care practice through educational audit and feedback, the QPIs may improve the quality use of medicines.