Prescribing quality indicators applicable to register data: A scoping review

Cross-linkable register data enable reuse of healthcare data to assess and improve prescribing quality. A first step in the developing of quality indicators is summarising existing evidence.

To identify prescribing quality indicators (PQIs) suitable for population-level assessment of outpatient prescribing across and within countries and regions, and applicable using the Nordic (Denmark, Iceland, Finland, Norway, Sweden) registers.

Bibliographic databases were searched for original research articles published 2000-2023 in English or Nordic languages from high-income European, North American, East Asian and Pacific countries. Eligible studies included at least one explicit PQI for assessing outpatient prescribing or pharmacotherapy quality, calculable using aggregate- or individual-level structured data on sales, consumption, prescriptions or dispensings. Exploratory and snowballing strategies were used to complement searches.

We identified 173 articles, of which 90% focused solely on pharmacotherapy and 10% had a broader service scope. Fifty-one percent focused on a specific disease or medication class (e.g., asthma, diabetes, opioids, antibiotics), 35% on a specific population subgroup (e.g. older adults, children), and 14% had a more general scope (e.g. general practitioner prescribing). We extracted 11 lists of potentially inappropriate medicines (PIM) for older adults validated for Nordic/European settings, and 915 PQIs. All PQIs adressed process dimension and 96% the effectiveness/safety aspects of quality; 50% required individual-level data on dispensings and diagnoses, 35% individual-level data on dispensings, and 16% were calculable using aggregate data.

Numerous register-applicable PQIs were identified, providing a basis for further quality framework development and validation across purposes and contexts.