Quality control of drug prescriptions by positive lists--the European Formulary

The overall quality of drug prescription is based on three elements: structural, procedural and result quality. In order to improve the clinical outcome (= result quality) of a patient, only drugs with a proven efficacy and a well known risk/benefit-relation should be prescribed. However, in 1992 in Germany, 31.1% of the ambulatory drug prescriptions were for drugs with questionable efficacy or dubious combination preparations. These expenditures therefore cannot be justified, neither from a pharmacological point of view nor from an economic standpoint. One of the main reasons for this poor prescribing quality is a poor structural quality, i.e. too many drugs and lack of transparency on the market and a producer-oriented drug information. In order to improve this structural quality, a drug list will be established by a group of 33 pharmacologists, physicians and pharmacists from 15 European countries. This list aims at 66 diseases, which are thought to be the most common for the general practitioners everyday routine. For these illnesses drug therapies are recommended including information on drug side-effects, possible interactions and contra-indications. Furthermore, basing on published literature, all possible drugs for the 66 indications will be discussed explaining and underlining the choice of the European Formulary Group. However, even a comprehensive drug list may not rule out insufficient procedural quality, i.e. too lengthy prescriptions of benzodiazepines, but may hopefully facilitate the rational choice of drugs and therefore improve patients outcome.