Compliance with quality prescribing indicators in terms of their relationship to financial incentives

• Published in: European journal of clinical pharmacology 2013-10, Vol.69 (10), p.1845-1853
• Main Authors: Fernández Urrusuno, Rocío, Montero Balosa, Ma Carmen, Pérez Pérez, Pastora, Pascual de la Pisa, Beatriz
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Catchment Area (Health); Cross-Sectional Studies; Drug Prescriptions - economics; Drug Prescriptions - standards; Drug Prescriptions - statistics & numerical data; Family physicians; Fee-for-Service Plans - economics; Fee-for-Service Plans - organization & administration; Fee-for-Service Plans - standards; Guideline Adherence; Medical sciences; Monetary incentives; Pharmacoepidemiology and Prescription; Pharmacology. Drug treatments; Pharmacology/Toxicology; Physician Incentive Plans - economics; Physician Incentive Plans - organization & administration; Practice Patterns, Physicians' - economics; Practice Patterns, Physicians' - standards; Prescription Drugs - economics; Prescriptions; Primary care; Primary Health Care - economics; Primary Health Care - organization & administration; Primary Health Care - standards; Quality Indicators, Health Care - economics; Quality Indicators, Health Care - standards; Quality of care; Reimbursement, Incentive - economics; Reimbursement, Incentive - standards; Spain
• ISSN: 0031-6970; 1432-1041
• DOI: 10.1007/s00228-013-1542-4

Objective To develop quality prescribing indicators for general practitioners (GPs) who are non-monitored and not included in pay-for-performance programs, and to determine compliance with incentivized and non-incentivized indicators. Study design Descriptive cross sectional study. Setting : Aljarafe Primary Health Care Area (Andalusian Public Health Care Service, Spain), a rural and suburban area with a population of 323,857 inhabitants. Health assistance in this area is provided by 176 GPs in 37 health centers. Prescribing indicators were developed by a multidisciplinary group using a qualitative technique based on consensus. The members of the consensus group searched for updated recommendations focused on clinical evidence. Prescribing data were obtained from the computerised pharmacy records of reimbursed drugs and clinical data from the electronic clinical databases and hospital admission records. Results Fourteen indicators based on the selection of drugs of different therapeutic groups or linked to patient´s clinical information were designed. The compliance with indicators based on the selection of drugs linked to financial incentives was higher than that of indicators not linked to financial incentives. The compliance with indicators based on clinical information varied widely. Inappropriate prescribing ranged from 7 %, in the use of long-acting beta-agonists in asthma, to 86 % in the use of drugs for the prevention of osteoporotic fractures in young women. Conclusions This study shows better compliance by GPs with indirect and incentivized quality prescribing indicators, included in pay-for-performance programs, compared with not-incentivized indicators based on the relative use of drugs and on the appropriateness prescribing.