New indicators to guide ‘gold-standard prescribing’

GPs are a step closer to having an evidence-based guide to safer prescribing, with researchers identifying a set of quality prescribing indicators (QPIs) for common conditions in Australian primary care.
 
The 23 QPIs were developed by a team at Monash University, including two prominent GPs and three pharmacists, who conducted a rigorous review and consensus process, with the outcome published in the BMJ Quality & Safety.
 
They cover seven major therapeutic areas – proton pump inhibitors, vaccinations, blood pressure medications, anti-inflammatories, asthma inhalers, mental health treatments and pain relief – and provide information on the appropriate initiation of medicines, ongoing monitoring, avoiding high-risk prescribing combinations and deprescribing.
 
If widely adopted, researchers say it could help reduce medication-related harms, prevent avoidable hospital admissions, lower healthcare costs and improve patient outcomes.
 
While indicators are commonplace in a number of health systems, Australian primary care does not have a current set, with previous QPIs being outdated and only relevant to older patients.
 
According to the research, medication-related problems place a substantial cost burden on hospitals through preventable admissions, and while quality prescribing indicators offer a proven way to evaluate and improve medicine use, Australia has lacked an updated, nationally recognised set for primary care since 2006.
 
One of the paper’s authors and Chair of RACGP Expert Committee – Research, Professor Dimity Pond, said these new QPIs cover a range of common prescribing areas in general practice settings and also ‘reflect evolving prescribing risks and contemporary general practice priorities’.
 
‘The indicators were designed to address prescribing practices that may not align with best practice for whatever reason,’ she told newsGP.
 
‘We hope the indicators would draw attention to these areas and provide clarity in specific instances, particularly where there is increased risk of medication-related harm.’
 
Professor Pond adds that she hopes the indicators will have an ongoing role in general practice.
 
‘I’d like to see the QPIs well integrated into routine existing quality improvement activities and workflows, and supported with educational resources and engagement to ensure GPs are seeing the benefit of the indicators with limited additional admin burden,’ she said.
 
‘I would also see them potentially becoming part of routine clinic level practice, via audit and feedback mechanisms where prescribing data could be analysed periodically to highlight areas of strength and identify opportunities for improvement.
 
‘Involvement of GPs in the review and analysis of this data would also make for a beneficial and insightful source of measuring outcomes CPD.’
 
Senior author Associate Professor Johnson George, from Monash University’s Centre for Medicine Use and Safety, described the new framework as a critical step forward for patient safety and clinical practice.
 
‘This study provides Australia with a validated set of 23 prescribing indicators that can be used to guide gold-standard prescribing in primary care, by all health professionals,’ he said.
 
‘Developed and endorsed by an expert panel of general practitioners, nurse practitioners and pharmacists and the professional bodies, these indicators offer a practical way to identify potentially inappropriate prescribing, monitor practices and support improvements in the safe and effective use of medicines.’
 
The next phase of the research, part of the broader $4 million MRFF APRICOT project, will involve a randomised controlled trial, testing the indicators in primary care clinics alongside an educational audit, feedback and other strategies to support and enhance medication safety.
 
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quality prescribing indicators quality use of medicines safe prescribing