A scoping review of quality prescribing indicators, rules and criteria for primary care

Medication-related problems (MRPs) place a substantial burden on the healthcare system, contributing to hospital admissions and significant healthcare costs. Quality prescribing indicators (QPIs), rules and criteria serve to educate prescribers about high risk MRPs and to monitor prescribing behaviours. This study aims to summarize existing indicators, rules and criteria for quality prescribing of medicines in primary care. Four databases (OVID-MEDLINE, OVID-Embase, EBSCOhost-PsycINFO and ProQuest-International Pharmaceutical Abstracts) were searched for studies published between 2000 and 2025, across three intersecting areas: (i) general or family practice setting, (ii) prescriptions/medicines/medication/drugs and (iii) quality indicators/rules/best practice. Artificial intelligence software ASReview® assisted by prioritizing titles and abstracts for screening. To be included, the manuscript had to describe the development of novel rules relevant to primary care settings, be specific to medications or conditions and not address the general writing of a prescription. Of the 41 962 papers identified, 1859 were title and abstract screened by the review team before reaching our threshold of 420 consecutively irrelevant papers. Full-text review of 133 papers, including 11 reviews of QPIs, resulted in 1486 prescribing rules, covering 54 therapeutic areas, being extracted. Most studies focused on older patients, only three specified they were applicable to a general adult population and six focused on specific medical conditions. Therapeutic groups with the most rules were psychoanaleptics, psycholeptics and antithrombotic agents. This review highlights the breadth of prescribing rules, limited methodological diversity and the need for future research to optimize emerging therapies.