title: Development and validation of prescribing quality indicators for patients with type 2 diabetes.
abstract: OBJECTIVE
  Quality indicators are used to measure whether healthcare professionals act according to guidelines, but few indicators focus on the quality of pharmacotherapy for diabetes. The aim of this study was to develop and validate a set of prescribing quality indicators (PQIs) for type 2 diabetes in primary care, and to apply this set in practice. To take into account the stepwise treatment of chronic disease, clinical action indicators were specifically considered.
  
  
  METHODS
  Potential PQIs were derived from clinical practice guidelines and evaluated using the RAND/UCLA Appropriateness Method, a modified Delphi panel. Thereafter, the feasibility of calculating the PQIs was tested in two large Dutch primary care databases including >80 000 diabetes patients in 2012.
  
  
  RESULTS
  32 PQIs focusing on treatment with glucose, lipid, blood pressure and albuminuria lowering drugs, and on vaccination, medication safety and adherence were assessed by ten experts. After the Delphi panel, the final list of twenty PQIs was tested for feasibility. All PQIs definitions were feasible for measuring the quality of medication treatment using these databases. Indicator scores ranged from 18.8% to 90.8% for PQIs focusing on current medication use, clinical action and medication choice, and from 2.1% to 37.2% for PQIs focusing on medication safety.
  
  
  CONCLUSIONS
  Twenty PQIs focusing on treatment with glucose, lipid, blood pressure and albuminuria lowering drugs, and on medication safety in type 2 diabetes were developed, considered valid and operationally feasible. Results showed room for improvement, especially in initiation and intensification of treatment as measured with clinical action indicators.
authors.affiliation: Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Kirsten P J
authors.initials: KP
authors.lastname: Smits
authors.affiliation: Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Grigory
authors.initials: G
authors.lastname: Sidorenkov
authors.affiliation: Langerhans Medical Research Group, Zwolle, The Netherlands.|Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Nanno
authors.initials: N
authors.lastname: Kleefstra
authors.affiliation: Dutch College of General Practitioners (NHG), Utrecht, The Netherlands.
authors.forename: Margriet
authors.initials: M
authors.lastname: Bouma
authors.affiliation: Dutch Institute for Rational Use of Medicine (IVM), Utrecht, The Netherlands.
authors.forename: Marianne
authors.initials: M
authors.lastname: Meulepas
authors.affiliation: Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jaco
authors.initials: J
authors.lastname: Voorham
authors.affiliation: Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Gerjan
authors.initials: G
authors.lastname: Navis
authors.affiliation: Diabetes Centre, Isala Clinics, Zwolle, The Netherlands.
authors.forename: Henk J G
authors.initials: HJ
authors.lastname: Bilo
authors.affiliation: Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Denig
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000188:drug therapy; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002908:Chronic Disease; D016208:Databases, Factual; D003697:Delphi Technique; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy; D006973:Hypertension / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents
keywords: diabetes mellitus; evidence-based medicine; performance measures; primary care; quality measurement