A systematic literature review: prescribing indicators related to type 2 diabetes mellitus and cardiovascular risk management.
OBJECTIVE
Valid prescribing indicators (PI) are needed for reliable assessment of prescribing quality. The purpose of this study is to describe the validity of existing PI for type 2 diabetes mellitus and cardiovascular risk management.


METHODS
We conducted a systematic literature search for studies describing the development and assessment of relevant PIs between January 1990 and January 2009. We grouped identified PI as drug- or disease-oriented, and according to the aspects of prescribing addressed and the additional clinical information included. We reviewed the clinimetric characteristics of the different types of PI.


RESULTS
We identified 59 documents describing the clinimetrics of 16 types of PI covering relevant prescribing aspects, including first-choice treatment, safety issues, dosing, costs, sufficient and timely treatment. We identified three types of drug-oriented, and five types of disease-oriented PI with proven face and content validity as well as operational feasibility in different settings. PI focusing on treatment modifications were the only indicators that showed concurrent validity. Several solutions were proposed for dealing with case-mix and sample size problems, but their actual effect on PI scores was insufficiently assessed. Predictive validity of individual PI is not yet known.


CONCLUSIONS
We identified a range of existing PI that are valid for internal quality assessment as they are evidence-based, accepted by professionals, and reliable. For external use, problems of patient case-mix and sample size per PI should be better addressed. Further research is needed for selecting indicators that predict clinical outcomes.
Martirosyan
Liana
L
Department of Clinical Pharmacology, University Medical Centre Groningen, University of Groningen, the Netherlands. l.d.martirosyan@med.umcg.nl
Voorham
Jaco
J
Haaijer-Ruskamp
Flora M
FM
Braspenning
Jozé
J
Wolffenbuttel
Bruce H R
BH
Denig
Petra
P
D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000592:standards*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012306:Risk