Markers to analyse the prescribing of non steroidal anti-inflammatory drugs in ambulatory care - A guide to pursuing rational and safe prescribing

Objective: The aim of the study is to construct quality markers for rationa l prescribing of non-steroidal anti-inflammatory drugs (NSAIDs M01A, M01B) in such a manner that they meet three requirements: suitability to be asses sed by prescription analysis, application in feedback strategies and contri bution to the task of internal quality assurance. Method: Eight different markers for validating NSAID prescribing were devel oped according to pharmacological literature. The prescribing of 99 partici pants thigh prescribers) and 15 coordinators of eight pharmacotherapy circl es (second quarter 1996) served as the database. To test the validity of th e markers in terms of rationality, the NSAID prescribing of 15 randomly sel ected participants of these circles, whose participants were not trained in the analysis of their prescribing, was compared with the prescribing of th e 15 coordinators of these circles, who had considerable experience in phar macotherapy and group auditing. In order to compare results according to th e age and sex of the patients, the two groups treated with NSAIDs were also matched (460 patients in each group). The drugs are classified under the A TC code with the volume given in defined daily doses (DDDs). Results: Marker 1 - the percentage of NSAID DDDs for recommended drugs, i.e . ibuprofen, diclofenac, indomethacin and naproxen - was significantly high er for the coordinators in comparison with the high prescribers (P < 0.05). Therefore, marker 3 (drugs with questionable efficacy) and marker 5 ('me-t oo' drugs) show an inverse relation. Drugs with a long half-life (marker 2) , high-risk drugs (marker 4) and newly marketed drugs (marker 6) were all s eldomly prescribed by both groups of doctors. There was no difference betwe en the two groups of prescribers concerning the proportion of elderly peopl e treated with NSAIDs (marker 7). With reference to marker 8 - co-medicatio n with anti-ulcer drugs - the coordinators treated 8.9% of NSAID patients w ith antacids and anti-ulcer drugs, the high prescribers, on the other hand, treated 12.2% (NS). Conclusion: The markers can be easily assessed using the information obtain ed from drug claims and shown to each doctor personally. They call for the doctors to pay special attention to their particular drug selection. The ma rkers can be implemented into feedback strategies of prescribing habits.