New indicators a 'clinical compass' for prescribing in primary care

Researchers from Australia and internationally have developed 23 quality prescribing indicators (QPI) in a bid to reduce the burden of medication errors.

These indicators act as a clinical compass to guide safe and appropriate prescribing for common health conditions in all adults in primary care across Australia, the researchers said in a statement.

Medication errors and related problems remain one of the most common issues in healthcare. Across Australia each year some 250,000 hospital admissions are due to medication-related errors, at a cost of about $1.4 billion.

While quality prescribing indicators offer a proven way to evaluate and improve medicine use, Australia has lacked an updated, nationally recognised set of indicators for primary care since 2006, researchers said.

The research, undertaken by Monash University, was published in BMJ Quality and Safety. The research team included five practising clinicians; three pharmacists and two GPs.

Senior author Associate Professor Johnson George, from the Centre for Medicine Use and Safety at the Monash Institute of Pharmaceutical Sciences (MIPS), said the new framework was 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 indicators provide information on the appropriate initiation of medicines, ongoing monitoring, avoiding high-risk prescribing combinations and deprescribing when medications are no longer necessary.

They cover seven major therapeutic areas, including proton pump inhibitors, vaccinations, blood pressure medications, anti-inflammatories, asthma inhalers, mental health treatments and pain relief.

Quality performance indicators for primary care

Below are examples of some of the QPIs presented in the research:

· Prescribe the influenza vaccine annually for patients aged 65 years or older, Aboriginal and Torres Strait Islander people, people with medical conditions that increase their risk of severe influenza and pregnant women, unless allergic to vaccine components.

· When treating osteoarthritis pain, only consider long-term oral NSAIDs if the patient is at low risk of harm from NSAID use.

· Patients with asthma should be prescribed an inhaled corticosteroid.

· Avoid using gabapentin or pregabalin for general pain, as they are only indicated for neuropathic pain.

· Prescribe a proton pump inhibitor and antibiotics for all patients who test positive to Helicobacter pylori.

· Avoid co-prescribing ACE inhibitors and potassium salts or potassium-sparing diuretics without regular monitoring of renal function and electrolytes.

Second author of the study Anna Mackintosh, the project manager at MIPS for the Medical Research Future Fund project APRICOT, said the research could have a real impact on the safety of prescribing.

“If our indicators are adopted widely, they could help healthcare professionals prescribe medicines more safely in primary care. Over time, this could reduce medication-related harms, prevent avoidable hospital admissions, lower healthcare costs and ultimately improve patient outcomes,” Ms Mackintosh said.

The indicators are set to be tested in an upcoming randomised controlled trial as part of the broader APRICOT project, which includes partner organisations including the RACGP and Australian Primary Care Nurses Association.