Development of indicators for assessing the quality of prescribing of lipid-lowering drugs: data from the pharmacotherapeutic quality circles in Hesse, Germany

Objective: To develop indicators based on prescription analysis in order to assess adherence using guidelines and to monitor prescribing behavior. Set ting an material: Eleven pharmacotherapeutic circles (PTC) of the Associati on of Statutory Health Insurance Physicians (KV Hesse; 10 PTCs including 15 5 GPs as participants, mostly high prescribers; one circle with I I moderat ors trained in pharmacology). These provided a total of 183,997 drug prescr iptions involving 54,970 patients (prescriptions reimbursed by the substitu te fund-Ersatzkassen-II. quarter 2000); claims form from 151 GPs. On averag e, 5.1% of the patients with prescriptions received lipid-lowering drugs. M ethod: Development and application of indicators based on the guideline for the treatment of hypercholesterolemia developed by a GP's guideline group of the quality circles in Hesse (Hausarztliche Leitliniengruppe Hessen). Th e ratio of prescribing for primary and secondary prevention was chosen as a top indicator for measuring adherence to the guideline. Prescribing for se condary prevention was assessed by a set of special diagnoses. The second i ndicator relates to patient groups (here: older than 75 years) where the be nefit of prescribing is not clear. Further indicators measure the pre-scrib ing of first choice drugs, avoidance of risk combinations and cost-consciou s prescribing. The indicators are presented in the prescription analysis an d will be discussed during the circle meeting. Results: On average, the mod erators prescribed 34% of the lipid-lowering drugs for primary prevention, the GP circle participants 36.7%. On average, moderators and GP participant s prescribed lipid-lowering drugs for 4.9% and 7.5% of patients older than 75 years, respectively (6% and 22% in primary prevention). Approximately, 2 8% of all lipid-lowering drugs issued by the participants involved simvasta tin and pravastatin as first-choice drugs compared to 36.5% in the case of the moderators. The prescribing of statins with fibrates or macrolides in c ombination is seldom. Cost-conscious prescribing can be assessed for each G P by the percentage of generic prescribing and the number of different bran ds per active agent. Both, moderators and participants used generics when p rescribing fibrates, bile acid sequestrants or other types of lipid-lowerin g drugs (moderators 53.8% and GP participants 78.5%). Three months is too s hort a period for assessing compliance of lipid-lowering drug prescribing. Conclusion: It is possible to derive indicators from the guidelines and to integrate them into prescription analysis. The indicators reveal prescribin g problems. The evaluation of PTCs in 2002 will involve the use of indicato rs as an instrument to assess the success in the implementation of guidelin es.