Skip to main content

Table 4 Quality assessment criteria generated from candidates that the RAM panel classified as 'appropriate but not necessary to do' (A) and 'appropriate and necessary to do' (N)

From: Quality and safety of medication use in primary care: consensus validation of a new set of explicit medication assessment criteria and prioritisation of topics for improvement

Topic No.

Treatment targeted - Associated PDRM event (Medication quality category)

HYPERTENSION

Q1

Selection of first line antihypertensives - Hypertension complications (MQ2)

 

1. (N) Patient with HTN and without CHD - is started on antihypertensive treatment with a first-line antihypertensive

Q2

Treatment to blood pressure (BP) target - Hypertension complications (MQ3)

 

Patient aged < 75 years, who has a history of hypertension WITHOUT complications

 

2. (N) and BP is > 150/90 mmHg on < 3 antihypertensive drugs - has antihypertensive treatment intensified

 

3. (N) and BP is > 140/85 mmHg on < 2 antihypertensive drugs - has antihypertensive treatment intensified

 

4. (A) and BP is > 140/85 mmHg on < 3 antihypertensive drugs - has antihypertensive treatment intensified

 

Patient aged ≥ 75 years, who has a history of hypertension WITHOUT complications

 

5. (N) and BP is > 150/90 mmHg on < 2 antihypertensive drugs - has antihypertensive treatment intensified

 

6. (N) and BP is > 140/85 mmHg without antihypertensive treatment - has antihypertensive treatment started

 

7. (A) and BP is > 150/90 mmHg on < 3 antihypertensive drugs - has antihypertensive treatment intensified

 

8. (A) and BP is > 140/85 mmHg on < 2 antihypertensive drugs - has antihypertensive treatment intensified

 

Patient aged < 75 years, who has a history of hypertension WITH complications

 

9. (N) and BP is > 130/80 mmHg on < 2 antihypertensive drugs - has antihypertensive treatment intensified

 

Patient aged ≥ 75 years, who has a history of hypertension WITH complications

 

10. (N) and BP is > 140/85 mmHg on < 2 antihypertensive drugs - has antihypertensive treatment intensified

 

11. (N) and BP is > 130/80 mmHg without antihypertensive treatment - has antihypertensive treatment intensified

 

12. (A) and BP is > 140/85 mmHg on < 3 antihypertensive drugs - has antihypertensive treatment intensified

 

13. (A) and BP is > 130/80 mmHg on < 2 antihypertensive drugs - has antihypertensive treatment intensified

DIABETES MELLITUS

Q3

Treatment to HbA1c target - Diabetes complications (MQ3)

 

Patient with diabetes mellitus type 2,

 

14. (N) who has HbA1c of > 7% on < 2 oral antidiabetic drugs - has antidiabetic treatment intensified

 

15. (N) who has HbA1c of > 9% on < 3 oral antidiabetic drugs - has antidiabetic treatment intensified

 

16. (A) who has HbA1c of 6.6 to 7% without antidiabetic treatment - has antidiabetic treatment intensified

 

17. (A) who has HbA1c of 7.6 to 9% on < 3 oral antidiabetic drugs - has antidiabetic treatment intensified

Q4

Selection of first line oral antidiabetic - Diabetes complications (MQ2)

 

18. (N) Patient with diabetes mellitus type 2, who is overweight - is started on metformin

Q5

Indication for ACEI or ARB in patients with renal complications - Diabetes complications (MQ1)

 

19. (N) Patient with diabetes mellitus and micro-albuminuria - is prescribed an ACEI or ARB

AT RISK OF/MANIFEST VASCULAR DISEASE

Q6

Indication for statin in patients with manifest vascular disease or risk factors - Vascular events (MQ1)

 

20. (N) Patient with previous vascular events (MI, stroke or TIA) - is prescribed a statin

 

21. (N) Patient with peripheral vascular disease - is prescribed a statin

 

22. (N) Patient aged > 40 with DM without established vascular disease - is prescribed a statin

 

23. (A) Patient with 10 year CVD risk > 20% without diabetes - is prescribed a statin

Q7

Treatment to target statin dose in patients with manifest vascular disease or risk factors - Vascular events (MQ4)

 

24. (N) Patient with previous vascular events (MI, stroke or TIA) - is prescribed simvastatin ≥ 40 mg/d (or equivalent)

 

25. (N) Patient with peripheral vascular disease - is prescribed simvastatin ≥ 40 mg/d (or equivalent)

 

26. (N) Patient aged > 40 with DM without established vascular disease - is prescribed simvastatin ≥ 40 mg/d (or equiv.)

 

27. (N) Patient with 10 year CVD risk > 20% without diabetes - is prescribed simvastatin ≥ 40 mg/d (or equivalent)

Q8

Indication for thrombo-embolic prophylaxis in patients with CHD - Vascular events (MQ1)

 

28. (N) Patient with previous vascular events (MI, stroke or TIA) - is prescribed any thrombo-embolic prophylaxis

 

29. (N) Patient with a history of peripheral vascular disease - is prescribed any thrombo-embolic prophylaxis

 

Indication for dual antiplatelets in CHD with a history of ACS - Vascular events (MQ1)

 

30. (N) Patient with previous stroke/TIA - is co-prescribed aspirin and dipyridamole (unless on warfarin or clopidogrel)

 

31. (N) Patient with ACS 0 to 3 months ago - is co-prescribed aspirin and clopidogrel (unless on warfarin)

 

32. (A) Patient with ACS 4 to 9 months ago - is co-prescribed aspirin and clopidogrel (unless on warfarin)

Q9

Indication for beta blockers in CHD - Vascular events (MQ1)

 

33. (N) Patient with a history of acute coronary syndrome - is prescribed a beta blocker

 

34. (N) Patient with stable angina without a history of acute coronary syndrome - is prescribed a beta blocker

Q10

Indication for ACEI or ARB in CHD - Vascular events (MQ1)

 

35. (N) Patient with a history of acute coronary syndrome - is prescribed an ACEI or ARB

 

36. (A) Patient with stable angina without a history of acute coronary syndrome - is prescribed an ACEI or ARB

CHRONIC HEART FAILURE

Q11

Indication for ACEI or ARB in CHF - Heart failure progression (MQ1)

 

37. (N) Patient with CHF - is prescribed an ACE or ARB

Q12

Indication for Beta blocker in CHF - Heart failure progression (MQ1)

 

38. (N) Patient with CHF - is prescribed a beta blocker

 

Selection of licensed beta blocker in CHF - Heart failure progression (MQ2)

 

39. (A) Patient with CHF and treated with a BB - is prescribed a BB licensed for CHF

Q13

Treatment to target dose (ACEI and ARB) in CHF - Heart failure progression (MQ4)

 

40. (N) Patient with CHF and treated with an ACEI or ARB - has achieved the recommended target dose

Q13

Treatment to target dose (beta blocker) - CHF- Prevention of heart failure progression (MQ4)

 

41. (N) Patient with CHF and treated with a beta blocker - has achieved the recommended target dose

ATRIAL FIBRILLATION

Q14

Indication for thrombo-embolic prophylaxis in AF - Thrombo-embolism (MQ1)

 

42. (N) Patient with atrial fibrillation and a CHADS2 score of 0 or 1 - is prescribed thrombo-embolic prophylaxis

 

43. (N) Patient with atrial fibrillation and a CHADS2 score of 2 - is prescribed thrombo-embolic prophylaxis

 

44. (N) Patient with atrial fibrillation and a CHADS2 score ≥ 3 - is prescribed thrombo-embolic prophylaxis

Q15

Selection of thrombo-embolic prophylaxis in AF - Thrombo-embolism (MQ2)

 

45. (N) Patient with AF and a CHADS2 score ≥ 3 treated with an antithrombotic - is prescribed an oral anticoagulant

ASTHMA

Q16

Indication for inhaled corticosteroids in asthma - Asthma exacerbation (MQ1)

 

Patient aged > 4 with asthma but without COPD and

 

46. (N) is treated with a step 3 drug* - is also prescribed an inhaled corticosteroid

 

47. (N) has received oral prednisolone in last 12 weeks - is also prescribed an inhaled corticosteroid

 

48. (N) has received ≥ 3 prescriptions of SABAs in last 12 weeks - is also prescribed an inhaled corticosteroid

 

49. (A) has received 2 prescriptions of SABAs in last 12 weeks - is also prescribed an inhaled corticosteroid

 

* long acting beta agonist, leukotriene receptor antagonist or theophylline

OSTEOPOROSIS

Q17

Indication for bone protecting agents in patients with osteoporosis - Fractures (MQ1)

 

50. (N) Female patient with osteoporosis who had a vertebral fracture - is prescribed a bone protecting agent*

 

* a bisphosphonate, strontium ranelate, raloxifene or teriparatide

Q18

Indication for Calcium/vitamin D in patients at risk of osteoporosis - Fractures (MQ1)

 

51. (N) Female patient aged ≥ 80 who is housebound - is prescribed calcium and vitamin D

 

52. (N) Female patient aged ≥ 80 who lives in a nursing home/residential care - is prescribed calcium and vitamin D

  1. The criteria are organised hierarchically by medical condition, followed by the drug group targeted, quality topic scored in the Delphi study (Q) and by medication use quality category (MQ). MQ1 = indication for beneficial treatment, MQ2 = Selection of most effective option within drug class, MQ3 = Achievement of intermediate outcome target, MQ4 = Achievement of target dose