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Abstract
Objective All healthcare systems require valid ways to evaluate service delivery. The objective of this study was to identify existing content validated quality indicators (QIs) for responsible use of medicines (RUM) and classify them using multiple frameworks to identify gaps in current quality measurements.
Design Systematic review without meta-analysis.
Setting All care settings.
Search strategy CINAHL, Embase, Global Health, International Pharmaceutical Abstract, MEDLINE, PubMed and Web of Science databases were searched up to April 2018. An internet search was also conducted. Articles were included if they described medication-related QIs developed using consensus methods. Government agency websites listing QIs for RUM were also included.
Analysis Several multidimensional frameworks were selected to assess the scope of QI coverage. These included Donabedian’s framework (structure, process and outcome), the Anatomical Therapeutic Chemical (ATC) classification system and a validated classification for causes of drug-related problems (c-DRPs; drug selection, drug form, dose selection, treatment duration, drug use process, logistics, monitoring, adverse drug reactions and others).
Results 2431 content validated QIs were identified from 131 articles and 5 websites. Using Donabedian’s framework, the majority of QIs were process indicators. Based on the ATC code, the largest number of QIs pertained to medicines for nervous system (ATC code: N), followed by anti-infectives for systemic use (J) and cardiovascular system (C). The most common c-DRPs pertained to ‘drug selection’, followed by ‘monitoring’ and ‘drug use process’.
Conclusions This study was the first systematic review classifying QIs for RUM using multiple frameworks. The list of the identified QIs can be used as a database for evaluating the achievement of RUM. Although many QIs were identified, this approach allowed for the identification of gaps in quality measurement of RUM. In order to more effectively evaluate the extent to which RUM has been achieved, further development of QIs may be required.
- quality in health care
- quality of care
- quality indicators
- performance measures
- quality assurance
- quality measurement
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Footnotes
Contributors KF developed the review protocol and designed the review questions, carried out database search, articles screening, data extraction and classification and manuscript write up. RJM participated in protocol development, database search, articles screening, data extraction and classification and manuscript review. TFC participated in protocol development, conceptualising the review, designing review questions and database search, article screening, data extraction and classification and manuscript review.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Further details on studies included in this review can be retrieved by contacting the corresponding author.