SUPPLEMENTARY MATERIAL EJCL-D-13-00228R2

Article title: Compliers with quality prescribing indicators linked to financial incentives: what about not incentivized indicators?: an observational study

Journal: European Journal of Clinical Pharmacology

Authors name: Rocío Fernández Urrusuno, Pastora Pérez Pérez, Mª Carmen Montero Balosa, Cristina Márquez Calzada, Beatriz Pascual de la Pisa.

Affiliation and email address of the corresponding author:

Rocío Fernández Urrusuno

Primary Care Pharmacist

Distrito Sanitario Aljarafe-Sevilla Norte

Avda de las Américas s/n

41927-Mairena del Aljarafe (Spain)


Definition of prescribing indicators, standards and weights assigned to calculate synthetic quality indices

Development of quality prescribing indicators, rationale, evidence and rules has been published in full elsewhere (Fernández-Urrusuno R et al. (2013) Compliance with quality prescribing indicators in terms of their relationship to financial incentives. Eur J Clin Pharmacol 69:1845-1853).

Indicator number / Definition / Low
quality standard* / High
quality standard* / Weights assigned to calculate quality synthetic indices
Synthetic quality index I
1 / 1 / The percentage of thiazidea diuretics versus antihypertensive drugs / >15% / ≥20% / ≤15.0%=0
15.1-16.5%=2
16.6-18.0%=5
18.1-19.9%=8
≥20.0%=10
2 / The percentage of angiotensin-converting enzyme inhibitorb (ACEI) versus total ACEI or angiotensin II-receptor antagonistc (ARB II). / >59% / ≥75% / ≤59.0%=0
59.1-65.9%=4
66.0-69.9%=10
70.0-74.9%=16
≥75.0%=20
3 / The percentage of simvastatin versus statinsd. / >50% / ≥60% / ≤50.0%=0
50.1-51.9%=4
52.0-55.9%=10
56.0-59.9%=16
≥60.0%=20
4 / The percentage of metformin, glibenclamide, glipizide and glicazide versus oral antidiabetic drugs / >75% / ≥80% / ≤75.0%=0
75.1-75.9%=4
76.0-77.9%=10
78.0-79.9%=16
≥80.0%=20
5 / The percentage of ibuprofen and diclofenac versus non-steroidal anti-inflammatory drugs (NSAIDs). / >65% / ≥70% / ≤65.0%=0
65.1-65.9%=4
66.0-67.9%=10
68.0-69.9%=16
≥70.0%=20
6 / The percentage of omeprazole versus proton pump inhibitorse. / >85% / ≥90% / ≤85.0%=0
85.1-85.9%=2
86.0-87.9%=5
88.0-89.9%=8
≥90.0%=10
Synthetic quality index II / 7 / The percentage of alendronate and risedronate versus drugs for the prevention of osteoporotic fracturesf. / >65% / ≥73% / ≤63.0%=0
63.1-64.9%=4
65.0-67.9%=10
68.0-69.9%=16
≥70.0%=20
8 / The percentage of second and third line antibioticsg versus total antibiotics / <18% / ≤14% / ≥18.0%=0
17.9-17.1%=4
17.0-15.5%=10
15.4-14.1%=16
≤14.0%=20
9 / The ratio of long-acting beta-agonistsh (LABA) versus inhaled steroidsi. / <54 / ≤38 / ≥54.0=0
53.9-48.0=4
47.9-42.0=10
41.9-38.1=16
≤38.0=20
10 / The ratio of motelukast and zafirlukast versus inhaled steroidsi / <18 / ≤13 / ≥18.0=0
17.9-17.0=4
16.9-15.0=10
14.9-13.1=16
≤13.0=20
11 / The percentage short-acting bezodiazepines versus total anxiolytics and hypnoticsj. / >58% / ≥62% / ≥58.0%=0
58.1-59.0%=2
59.1-60.9%=5
61.0-61.9%=8
≥62.0%=10
12 / The percentage of cetirizine, loratadine and ebastine versus total second generation antihistaminesk / >71% / ≥78% / ≥71.0%=0
71.1-72.9%=2
73.0-75.9%=5
76.0-77.9%=8
≥78.0%=10
Synthetic quality index III / 13 / The percentage of patients with asthma treated with LABAh who are not using inhaled steroidsi. / Tend to zero / Not applicable
14 / The percentage of women under 65 years treated with drugs for the primary prevention of osteoporotic fracturesf / Tend to zero / Not applicable
15 / The percentage of patients receiving low doses acetylsalicylic acid (AAS) and NSAIDs without gastroprotective agents. / Tend to zero / Not applicable
16 / The percentage of patients aged over 65 years prescribed benzodiazepinesj for more than 6 months. / Tend to zero / Not applicable
17 / The percentage of patients who received atorvastatin 80 mg without indication / Tend to zero / Not applicable
18 / The percentage of patients with myocardial infarction who are not treated with ACEI, low doses of AAS and statins without justification / Tend to zero / Not applicable
19 / The percentage of patients prescribed oral anticoagulantsl and concomitant NSAIDs. / Tend to zero / Not applicable
20 / The percentage of patients with stroke or transient ischemic attack diagnosis with combination of low doses AAS and clopidogrel / Tend to zero / Not applicable

* Low and high-quality standards correspond to the 50th and 70th percentiles of the results from GPs in the area in 2006. Standards for indicators based on clinical conditions were not fixed, as they should be ideally closed to 100%.

aThiazide diuretics: hydochlorotiazide, chlorthalidone, indapamide.

bACEI: enalapril, captopril, ramipril, fosinopril, lisinopril, perindopril, quinapril, trandolapril and these drugs in combination products.

cARB: losartan, candesartan, eprosartan, irbesartan, telmisartan, olmesartan and these drugs in combination products.

dStatins: simvastatin, atorvastatin, fluvastatin, pravastatin, lovastatin.

eProton pump inhibitors: omeprazole, pantoprazole, esomeprazole, lansoprazole, rabeprazole.

fDrugs for the prevention of osteoporotic fractures: alendronate, risedronate, etidronate, ibandronate, zoledronate, raloxifen, strontium ranelate, calcitonin, teriparatide, alendronate/vitamin D.

gSecond and third line antibiotics: macrolides, third generation cephalosporins, fluorquinolones.

hLong acting beta agonists (LABA): salmeterol, formoterol.

iInhaled steroids: budesonide, fluticasone, mometasone, beclometasone. Inhaled steroids associated to long-acting beta-agonists: budesonide/formoterol, fluticasone/salmeterol.

jBenzodiazepines: alprazolam, bromazepam, clonazepam, diazepam, flunitrazetam, lorazepam, lormetazepam, oxazepam, triazolam.

kAnhithistamines: cetirizine, loratadine, ebastin, levocetirizine, rupatadine, desloratadine, fexofenadine, mizolastine and these drugs in combination products.

lOral anticoagulants: warfarin, acenocumarol.