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Abstract
Objective: The Dutch HARM-Wrestling (HW) Task Force issued general and drug-specific recommendations aimed at reducing hospital admissions related to medication (HARMs). This study examines if the drug-specific recommendations could be converted into indicators that could be monitored in existing databases of general practitioner (GP) or community pharmacy (CP) data. The study also assesses the performance of these indicators before and during the official release of HW recommendations.
Methods: HW recommendations were divided into sub-recommendations. We studied to what extent these were measurable as indicators based on available information in both databases. For each measurable indicator, performance between 2007 and 2010 was determined and possibilities for further improvement were estimated.
Results: Thirty-four drug-specific HW recommendations were divided into 69 sub-recommendations, 32 of which were measurable as indicator in at least one of the databases. Application of these indicators between 2007 and 2010 showed that many of the indicators did not change over time. Possibilities for further improvement were estimated as moderate to major for 16/31 (52%) indicators measured in the GP database and 6/15 (40%) HW indicators measured in the CP database.
Conclusions: Further implementation of the HW recommendations and development of additional monitoring methods are warranted to improve drug safety in outpatients.
Acknowledgments
We thank Menno Buurkens, general practitioner, and Wilma Göttgens, community pharmacist, for assessing the indicators on estimated possibilities for further improvement.
Declaration of interest
M Sturkenboom declared that she coordinates a research group that occasionally does project for Pharmaceutically companies, unrelated to this study. V Valkhoff declared that she as employee of Erasmus MC conducted research for Astra Zeneca. All other authors declare that there were no competing interests. This study was funded by the Dutch Ministry of Health, Welfare and Sport. Contributors: MF Warlé-van Herwaarden, PAGM De Smet and MCJM Sturkenboom contributed to conception and study design. AR Koffeman, GW 't Jong, MF Warlé-van Herwaarden and VE Valkhoff developed indicators in IPCI. VE Valkhoff and AR Koffeman ran indicators in IPCI. MT developed, ran and analyzed indicators in SFK. MF Warlé-van Herwaarden, AR Koffeman, VE Valkhoff and PAGM De Smet took part in the drafting phase of the manuscript. All authors contributed to the revision of the manuscript and took part in the interpretation of the results, and approved the final version of the report.