title: Compliance with quality prescribing indicators in terms of their relationship to financial incentives.
abstract: 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.
  
  
  METHODS
  Descriptive cross sectional study.
  
  
  METHODS
  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.
authors.affiliation: Service of Pharmacy, Aljarafe-Sevilla Norte Primary Health Care Area, Distrito Sanitario Aljarafe; Avda de las Américas s/n, 41927, Mairena del Aljarafe, Seville, Spain, rocio.fernandez.sspa@juntadeandalucia.es.
authors.forename: Rocío
authors.initials: R
authors.lastname: Fernández Urrusuno
authors.forename: Ma Carmen
authors.initials: MC
authors.lastname: Montero Balosa
authors.forename: Pastora
authors.initials: P
authors.lastname: Pérez Pérez
authors.forename: Beatriz
authors.initials: B
authors.lastname: Pascual de la Pisa
mesh_terms: D002391:Catchment Area, Health; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans / Q000191:economics / Q000458:organization & administration / Q000592:standards; D019983:Guideline Adherence; D010816:Physician Incentive Plans / Q000191:economics* / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards*; D055553:Prescription Drugs / Q000191:economics; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D019984:Quality Indicators, Health Care / Q000191:economics / Q000592:standards; D012052:Reimbursement, Incentive / Q000191:economics* / Q000592:standards; D013030:Spain
chemical_list: D055553:Prescription Drugs