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Table 7 Delphi study priority ratings by the 26 panellists

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

Median

Mean

Priority

 

Accepted as priorities

   
 

Quality

   

Q 16

Not using inhaled corticosteroids in patients with uncontrolled asthma

8

8.0

++

Q 15

Not using oral anticoagulants in patients with AF and high risk of stroke

8

7.9

++

Q 11

Not using ACEIs or ARBs in patients with a history of chronic heart failure

8

7.9

++

Q 14

Not using thrombo-embolic prophylaxis in AF patients at low/moderate risk of stroke

8

7.7

++

Q 5

Not using ACEIs or ARBs in patients with DM and renal complications

8

7.7

++

Q 12

Not using beta blockers in patients with a history of chronic heart failure

8

7.7

++

Q 4

Not using metformin as first line antidiabetic in overweight type 2 diabetics

8

7.6

++

Q 8

Not using antiplatelets in patients at risk of vascular events

7

7.5

+

Q 6

Not using statins in patients at high risk of cardiovascular events

7

7.4

+

Q 17

Not using bone sparing agents in female patients at high risk of fractures

7

7.3

+

Q 3

Low intensity antidiabetic treatment despite suboptimal HbA1c control

7

7.2

+

Q 10

Not using ACEIs or ARBs in patients with a history of ACS

7

7.0

+

Q 2

Low intensity antihypertensive treatment despite suboptimal BP control

7

6.9

+

Q 9

Not using beta blockers in coronary heart disease

7

6.8

+

Q 7

Underdosing of statins in patients at high risk of cardiovascular events

7

6.7

+

 

Safety

   

S 20

Using MTX without taking precautionary action to prevent patient overdosing

9

8.4

++

S 1

Not using gastro-protection in oral NSAIDs/antiplatelets users at high risk of bleeding

8

8.2

++

S 3

Using oral NSAIDs in patients at increased risk of renal failure

8

7.9

++

S 21

Inconsistent monitoring of FBC in patients on DMARDs

8

7.8

++

S 27

Using sedatives, antipsychotics, anticholinergics in elderly patients

7

7.3

+

S 19

Using bone protection in users of long term oral corticosteroids

7

7.3

+

S 23

Excess duration of female hormones in patients at risk of gynaecological cancer

7

7.3

+

S 10

Excess duration of potassium supplements and potassium sparing diuretics

7

7.2

+

S 28

Using drugs to avoid in patients with heart failure

7

7.1

+

S 18

Excessive dosing of digoxin in patients susceptible to digoxin toxicity

7

7.1

+

S 24

Inconsistent monitoring of thyroid function in patients prescribed amiodarone

7

7.0

+

S 6

Inconsistent monitoring of U&Es in patients at risk of electrolyte imbalance

7

7.0

+

S 14

Co-prescribing beta blockers and rate-limiting calcium channel blockers

7

6.9

+

S 25

Using theophylline in elderly COPD patients without a compelling indication

7

6.9

+

S 15

Using beta blockers in patients with active asthma

7

6.8

+

S 13

Not using of laxatives in strong opioid users

7

6.8

+

S 29

Using drugs to avoid in children and young adults

7

6.7

+

S 5

Using COX II inhibitors in patients at high risk of cardiovascular events

7

6.6

+

S 7

Using thiazide diuretics in patients with a history of CKD

7

6.6

+

S 17

Using long acting sulphonylureas in patients at risk of hypoglycaemia

7

6.6

+

S 4

Using COX II inhibitors without compelling indication (low dose aspirin users)

7

6.4

+

S 16

Using metformin in patients with CKD

7

6.4

+

S 26

Excessive dosing of statins in patients on interacting drugs

7

6.3

+

 

Not scored as priorities for medication improvement

   
 

Quality

   

Q 13

Inadequate dose titration of ACEI, ARBs and BBs in chronic heart failure

6

6.2

 

Q 1

Not using first line antihypertensives when initiating treatment for high blood pressure

6

6.4

 

Q 18

Not using calcium/vitamin D supplementation in female elderly patients

6

6.4

 
 

Safety

   

S 2

Using oral NSAIDs in the elderly without compelling indication (no previous trial of full dose paracetamol)

6

6.6

 

S 9

Using of aldosterone antagonists in patients with a history of CKD

6

6.5

 

S 11

Co-prescribing anti-infectives with high risk of affecting INR in patients on warfarin

6

6.4

 

S 12

Using warfarin without a compelling indication in AF with low risk of stroke

6

6.3

 

S 22

Using HRT in female patients at high risk of cardiovascular events

6

6.2

 

S 8

Not using allopurinol in thiazide users with a history of gout

6

5.8

 
  1. Topics are ranked by median scores. Clusters of topics with the same median are ranked in descending order of mean score. Topics with a median of 8 or higher ('high priority') are coded '++' and those with a median of 7 ('priority') '+'.