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 rational prescribing of non-steroidal anti-inflammatory drugs (NSAIDs MO1A, MO1B) in such a manner that they meet three requirements: suitability to be assessed by prescription analysis, application in feedback strategies and contribution to the task of internal quality assurance.


METHODS
Eight different markers for validating NSAID prescribing were developed according to pharmacological literature. The prescribing of 99 participants (high prescribers) and 15 coordinators of eight pharmacotherapy circles (second quarter 1996) served as the database. To test the validity of the markers in terms of rationality, the NSAID prescribing of 15 randomly selected participants of these circles, whose participants were not trained in the analysis of their prescribing, was compared with the prescribing of the 15 coordinators of these circles, who had considerable experience in pharmacotherapy and group auditing. In order to compare results according to the 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 ATC 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 higher for the coordinators in comparison with the high prescribers (P < 0.05). Therefore, marker 3 (drugs with questionable efficacy) and marker 5 ('me-too' 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 seldomly prescribed by both groups of doctors. There was no difference between the two groups of prescribers concerning the proportion of elderly people treated with NSAIDs (marker 7). With reference to marker 8 - co-medication with anti-ulcer drugs - the coordinators treated 8.9% of NSAID patients with antacids and anti-ulcer drugs, the high prescribers, on the other hand, treated 12.2% (NS).


CONCLUSIONS
The markers can be easily assessed using the information obtained from drug claims and shown to each doctor personally. They call for the doctors to pay special attention to their particular drug selection. The markers can be implemented into feedback strategies of prescribing habits.
Schubert
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I
Primary Health Care Research Unit, University of Cologne, Germany. Ingrid.Schubert@medizin.uni-koeln.de
Ihle
P
P
Köster
I
I
von Ferber
L
L
D000553:Ambulatory Care / Q000592:standards; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D015415:Biomarkers; D011307:Drug Prescriptions / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011786:Quality Control
D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers