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)

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


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

Dreischulte et al. BMC Clinical Pharmacology 2012 12:5   doi:10.1186/1472-6904-12-5

Open Data