Department of Clinical Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
BMC Health Serv Res. 2012 Jul 7;12:191. doi: 10.1186/1472-6963-12-191.
Information on prescribing quality of diabetes care is required by health care providers, insurance companies, policy makers, and the public. Knowledge regarding the opinions and preferences of all involved parties regarding prescribing quality information is important for effective use of prescribing quality indicators.
Between June and December 2009 we conducted semi structured interviews with 16 key-informants representing eight different organizations in the Netherlands involved in healthcare quality measurement and improvement. The interview guide included topics on participants' opinions and preferences regarding existing types of prescribing quality indicators in relation to their aim of using quality information. Content analysis methods were used to process the resulting transcripts following the framework of predetermined themes.
Findings from this qualitative study of stakeholder preferences showed that indicators focusing on undertreatment are found important by all participants. Furthermore, health care providers and policy makers valued prescribing safety indicators, insurance companies prioritized indicators focusing on prescribing costs, and patients' organization representatives valued indicators focusing on interpersonal side of prescribing. Representatives of all stakeholders preferred positive formulation of the indicators to motivate health care providers to participate in health improvement programs. A composite score was found to be most useful by all participants as a starting point of prescribing quality assessment. Lack of information on reasons for deviating from guidelines recommendations appeared to be the most important barrier for using prescribing quality indicators. According to the health care providers, there are many legitimate reasons for not prescribing the recommended treatment and these reasons are not always taken into account by external evaluators. The latter may cause mistrust of health care providers towards external stakeholders and limit the use of PQI in external quality improvement programs.
Prescribing quality indicators are considered to be an important tool for assessing quality of provided diabetes care by all participants, although the preferences for specific types of indicators may differ by stakeholder depending on their user aim. Introduction of information systems to register the reasons for deviating from the recommended drug treatment may contribute to a more widespread use of PQI for assessment of provided health care quality to diabetic patents. This study identified the potential preferences regarding quality indicators for diabetes care, and this could be used for development of questionnaires to conduct a survey among a larger group of participants.
医疗保健提供者、保险公司、政策制定者和公众都需要有关糖尿病护理处方质量的信息。了解所有相关方对处方质量信息的意见和偏好对于有效使用处方质量指标至关重要。
我们于 2009 年 6 月至 12 月间对 16 名关键信息提供者进行了半结构化访谈，这些受访者代表了荷兰 8 个不同的组织，这些组织均参与了医疗保健质量测量和改进工作。访谈指南包括参与者对现有各种处方质量指标的意见和偏好，以及他们使用质量信息的目的。采用内容分析方法，按照预定主题框架处理生成的转录本。
这项利益攸关方偏好的定性研究结果表明，所有参与者都认为侧重于治疗不足的指标很重要。此外，医疗保健提供者和政策制定者重视处方安全性指标，保险公司优先考虑侧重于处方成本的指标，而患者组织代表则重视侧重于处方人际方面的指标。所有利益攸关方的代表都更喜欢以积极的方式制定指标，以激励医疗保健提供者参与健康改善计划。所有参与者都认为综合评分是评估处方质量的起点，这是最有用的。缺乏偏离指南建议的原因的信息被认为是使用处方质量指标的最大障碍。根据医疗保健提供者的说法，不按照推荐的治疗方案进行治疗有很多合理的原因，而外部评估人员并不总是考虑这些原因。这可能会导致医疗保健提供者对外部利益相关者的不信任，并限制外部质量改进计划中 PQI 的使用。
所有参与者都认为处方质量指标是评估所提供糖尿病护理质量的重要工具，尽管由于用户目的不同，利益攸关方对特定类型的指标可能有不同的偏好。引入信息系统来记录偏离推荐药物治疗的原因可能有助于更广泛地使用 PQI 来评估提供给糖尿病患者的医疗保健质量。本研究确定了针对糖尿病护理的质量指标的潜在偏好，这可以用于开发调查问卷，以在更大的参与者群体中进行调查。
