title: Association between drug-specific indicators of prescribing quality and quality of drug treatment: a validation study.
abstract: OBJECTIVE
  To evaluate the concurrent validity of three European sets of drug-specific indicators of prescribing quality
  
  
  METHODS
  In 200 hip fracture patients (≥65 years), consecutively recruited to a randomized controlled study in Sahlgrenska University Hospital in 2009, quality of drug treatment at study entry was assessed according to a gold standard as well as to three drug-specific indicator sets (Swedish National Board of Health and Welfare, French consensus panel list, and German PRISCUS list). As gold standard, two specialist physicians independently assessed and then agreed on the quality for each patient, after initial screening with STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) and START (Screening Tool to Alert to Right Treatment).
  
  
  RESULTS
  According to the Swedish, French, and German indicator sets, 82 (41%), 54 (27%), and 43 (22%) patients had potentially inappropriate drug treatment. A total of 141 (71%) patients had suboptimal drug treatment according to the gold standard. The sensitivity for the indicator sets was 0.51 (95% confidence interval: 0.43; 0.59), 0.33 (0.26; 0.41), and 0.29 (0.22; 0.37), respectively. The specificity was 0.83 (0.72; 0.91), 0.88 (0.77; 0.94), and 0.97 (0.88; 0.99). Suboptimal drug treatment was 2.0 (0.8; 5.3), 1.9 (0.7; 5.1), and 6.1 (1.3; 28.6) times as common in patients with potentially inappropriate drug treatment according to the indicator sets, after adjustments for age, sex, cognition, residence, multi-dose drug dispensing, and number of drugs.
  
  
  CONCLUSIONS
  In this setting, the indicator sets had high specificity and low sensitivity. This needs to be considered upon use and interpretation.
authors.affiliation: Department of Clinical Pharmacology, Sahlgrenska University Hospital, Sweden.
authors.forename: Susanna M
authors.initials: SM
authors.lastname: Wallerstedt
authors.affiliation: Närhälsan Dals-Ed Health Center, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Belfrage
authors.affiliation: Aging Research Center, Karolinska Institutet and Stockholm University, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Fastbom
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions / Q000592:standards*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006620:Hip Fractures / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000639:trends; D008297:Male; D013548:Sweden / Q000453:epidemiology
keywords: drug therapy; health care quality assessment; indicator; pharmacoepidemiology; validity