TABLE 1.
Expert Panel Assessment Scores of QIs Grouped by Domain, 2011
| No. c | Domain | Type d | Data Collection with Questionnaire a | Final Rating of Expert Assessment b | ||||
|---|---|---|---|---|---|---|---|---|
| N (Response %) e | Comments (%) | Content Validity f | Absence of Selection Bias | Absence of Measurement Bias | Statistical Reliability g | |||
| 1 | Continuity of Careh | |||||||
| 1.1 | Checking and registration of current medication use | S | 1,807 (98.8) | 254 (14.1) | 1 | 1 | 0 | n/a |
| 1.2 | Management of interactions between oral anticoagulants and co-trimoxazole | S | 1,807 (98.7) | 344 (19.0) | 133 | 1 | 1 | n/a |
| 1.3 | Participation of pharmacotherapy audit meetings with GPs and community pharmacists | S | 1,807 (99.0) | 151 (8.4) | 0.534 | 0.5 | 0.5 | n/a |
| 1.4 | Percentage of patients with actual and verified documentation of current medication use prior to and after dispensing of medication | P | 1,807 (72.1) | 721 (39.9) | 1 | 1 | 0 | 0.5 |
| Mean score of QIs within this domain | 0.88 | 0.88 | 0.38 | 0.50 | ||||
| 2 | Patient Counseling | |||||||
| 2.1 | Percentage of users of inhalation medication who received instructions for the use of inhaler devices first dispensed | P | 1,807 (85.5) | 567 (31.4) | 0.5 | 0.5 | 0 | 1 |
| 2.2 | Percentage of benzodiazepine users who received verbal information about dependency with a follow-up prescription for benzodiazepines | P | 1,807 (91.3) | 440 (24.3) | 0 | 0.5 | 0 | n/a |
| 2.3 | Percentage of patient counseling pharmacy staff with demonstrable competency in patient counseling | S | 1,807 (91.4) | 321 (17.8) | 0 | 1 | 0.5 | 0 |
| Mean score of QIs within this domain | 0.17 | 0.67 | 0.17 | 0.50 | ||||
| 3 | Clinical Risk Management | |||||||
| 3.1 | Availability of protocols concerned with asking patients about potential contraindications | S | 1,807 (98.8) | 131 (7.2) | 1 | 1 | 1 | n/a |
| 3.2 | Asking the prescriber for confirmation of suspected contraindications | P | 1,807 (98.6) | 311 (17.2) | 0.5 | 0 | 0.5 | n/a |
| 3.3 | Percentage of patients chronically using loop diuretics and RAS inhibitors who are dispensed NSAIDs | O | 1,807 (98.0) | 166 (9.2) | 031 | 0.5 | 0.5 | 0 |
| 3.4 | Percentage of patients with documented contraindication of heart failure who are dispensed NSAIDs | O | 1,807 (74.5) | 532 (29.4) | 0.531 | 0.5 | 0 | 0.5 |
| 3.5 | Availability of protocols concerned with asking patients about possible drug intolerabilities | S | 1,807 (99.5) | 108 (6.0) | 1 | 1 | 1 | n/a |
| 3.6 | Documentation of the management of drug-drug interactions | S | 1,807 (99.3) | 209 (11.6) | 1 | 1 | 0 | n/a |
| 3.7 | Number of patients who concurrently use oral anticoagulants and co-trimoxazole | O | 1,807 (99.6) | 264 (14.6) | 035 | 0 | 0 | n/a |
| 3.8 | Number of patients who concurrently use oral anticoagulants and miconazole | O | 1,807 (99.6) | 89 (4.9) | 1 | 0.5 | 0 | n/a |
| 3.9 | Percentage of dispenses with quality assurance steps applied in the dispensing process | P | 1,807 (83.5) | 704 (39.0) | 0.536 | 0 | 0 | 1 |
| 3.10 | Availability of protocols concerning dose control of compounded medicine for systemic use | S | 1,807 (98.1) | n/a | 1 | 1 | 0 | n/a |
| 3.11 | Percentage of compounded medicine for systemic use with dose control | P | 1,807 (99.0) | 311 (17.2) | 1 | 1 | 0 | n/a |
| 3.12 | Patients using metformin in a daily dosage of 1,000 mg and above, with a creatinine clearance below 50 mL/min with medication adjustment according to creatinine clearance. | P | 1,807 (71.2) | 767 (42.4) | 1 | 0.5 | 0 | 0 |
| Mean score of QIs within this domain | 0.71 | 0.58 | 0.25 | 0.38 | ||||
| 4 | Compounding | |||||||
| 4.1 | Arrangements made for checks by compounding pharmacy in case of delegated compounding | S | 1,807 (94.4) | 334 (18.5) | 1 | 1 | 1 | n/a |
| 4.2 | Releasing technician compounded medicines by a pharmacist before dispensing to patients | S | 1,807 (83.0) | n/a | 1 | 1 | 1 | n/a |
| 4.3 | Stock compounding according to written protocols and nonstandardized compoundings according to guidelines | P | 666i (72.7) | 229 (34.4) | 1 | 1 | 0 | 0 |
| Mean score of QIs within this domain | 1.00 | 1.00 | 0.67 | 0 | ||||
| 5 | Dispensing of Medication | |||||||
| 5.1 | Percentage of community-dwelling patients aged > 65 years with medication dispensed in individualized dosage systems | P | 1,807 (95.0) | 231 (12.8) | 0 | 0 | 0.5 | 1 |
| 5.2 | Registration of errors during dispensing of medication, dispensed to patient | S | 322j (99.0) | n/a | 1 | 1 | 0 | 1 |
| 5.3 | Percentage of registered errors during dispensing of medication, dispensed to patient | P | 1,807 (94.8) | n/a | 0.5 | 0.5 | 0 | n/a |
| 5.4 | Availability of protocols on generic substitution for information to patients, prescribers, and persons who administer medicines | S | 1,807 (97.1) | 203 (11.2) | 0.5 | 0.5 | 0 | n/a |
| 5.5 | Compliance of individualized automated dispensing packages with national standards | S | 1,807 (98.0) | 159 (8.8) | 1 | 1 | 1 | n/a |
| 5.6 | Availability of control procedures for medication in weekly dosage forms (not automated) | S | 1,807 (99.6) | 115 (6.4) | 1 | 1 | 1 | n/a |
| Mean score of QIs within this domain | 0.67 | 0.67 | 0.42 | 1.00 | ||||
| 6 | Monitoring of Medication Use | |||||||
| 6.1 | Percentage of benzodiazepine users (aged > 65 years) who chronically use benzodiazepines | O | 1,807 (98.2) | 109 (6.0) | 0 | 0 | 1 | 0.5 |
| 6.2 | Number of medication reviews performed for patients with polypharmacy (> 5 different medication groups) | P | 1,807 (85.9) | 442 (24.5) | 0.537-39 | 0.5 | 0 | n/a |
| 6.3 | Percentage of classical NSAID users (aged > 70 years) with gastro protection | O | 1,807 (98.3) | 304 (16.8) | 131 | 0.5 | 0.5 | 0.5 |
| 6.4 | Percentage of patients who concurrently use nitrates and antithrombotics | O | 1,807 (97.7) | 242 (13.4) | 131 | 0.5 | 0.5 | 0.5 |
| 6.5 | Percentage of users of strong opiates who take laxatives (lactulose, magnesium oxide, bisacodyl, macrogol, or sennosides) | O | 1,807 (98.0) | 536 (29.7) | 131 | 0.5 | 0.5 | 0.5 |
| 6.6 | Percentage of dispensed third-generation chinolones | O | 1,807 (98.9) | 124 (6.9) | 0.5 | 0.5 | 1 | n/a |
| 6.7 | Monitoring and counseling of adherence to chronic medication used | P | 1,807 (89.4) | 378 (20.9) | 0.5 | 0 | 0 | n/a |
| 6.8 | Percentage of new and existing users of simvastatin who use simvastatin in a lower dose than according to national standards | O | 1,807 (92.3) | 309 (17.1) | 0 | 0.5 | 0 | 0.5 |
| 6.9 | Percentage of patients who use an antidepressant (SSRI) longer than 24 months continuously | O | 1,807 (97.5) | 383 (21.2) | 0 | 0 | 0 | 0.5 |
| 6.10 | Percentage of patients who continuously use proton pump inhibitors longer than 12 months | O | 1,807 (98.3) | 147 (8.1) | 0.5 | 0.5 | 1 | 1 |
| Mean score of QIs within this domain | 0.50 | 0.35 | 0.45 | 0.57 | ||||
| 7 | Self-Care Support | |||||||
| 7.1 | Following protocols for dispensing high-risk OTC medication | S | 1,807 (83.8) | n/a | 1 | 0.5 | 0 | n/a |
| 7.2 | Percentage of high-risk OTC medication dispensings according to protocol | P | 1,807 (66.9) | n/a | 0.5 | 0.5 | 0 | n/a |
| Mean score of QIs within this domain | 0.75 | 0.50 | 0.00 | |||||
| 8 | Logistics | |||||||
| 8.1 | Structures available for assessment of suppliers | S | 1,807 (99.6) | n/a | 1 | 1 | 1 | n/a |
| 8.2 | Assessment of reliability of suppliers | P | 3229 (100.0) | n/a | 1 | 1 | 1 | n/a |
| 8.3 | Availability of a valid expiration system | S | 1,807 (98.4) | n/a | 1 | 1 | 1 | n/a |
| 8.4 | Number of expired medicines dispensed to patients | P | 1,807 (83.8) | n/a | 1 | 0.5 | 0 | n/a |
| 8.5 | Number of inaccurately performed recalls of medicine | P | 1,807 (88.8) | 346 (19.1) | 1 | 1 | 0.5 | n/a |
| Mean score of QIs within this domain | 1.00 | 0.90 | 0.70 | |||||
| 9 | Quality Management | |||||||
| 9.1 | Registration of errors made during dispensing of medication, noticed within the pharmacy | S | 1,807 (86.7) | 454 (25.1) | 1 | 1 | 0 | 1 |
| 9.2 | Year of most recent evaluation of patients’ experiences | S | 1,807 (95.0) | 207 (11.5) | 1 | 1 | 1 | n/a |
| 9.3 | Number of registered complaints made by patients | P | 1,807 (47.3) | 285 (15.8) | 0.5 | 0.5 | 0 | 1 |
| 9.4 | Number of adverse drug reactions reported to the Netherlands Pharmacovigilance Centre | P | 1,807 (66.8) | 205 (11.3) | 0.5 | 0.5 | 0.5 | 1 |
| 9.5 | Availability of certified quality management system | S | 1,807 (99.8) | 201 (11.1) | 1 | 1 | 1 | n/a |
| 9.6 | Parameters for clinical risk management in the pharmacy information system are set up according to the prevailing standards | S | 1,807 (89.5) | 123 (6.8) | 1 | 1 | 1 | n/a |
| Mean score of QIs within this domain | 0.83 | 0.83 | 0.58 | 1.00 | ||||
| 10 | Professional Education | |||||||
| 10.1 | Professional development of pharmacy staff | P | 1,807 (87.1) | 514 (28.4) | 0.5 | 1 | 0 | 0 |
a Results from national data collection.
b Scores based on consensus meeting; for all criteria: 1 = meeting the requirements; 0.5 = partly meeting the requirements; 0 = not meeting the requirements.
c QIs assessed as valid on all criteria in bold.
d Indicator type: S = structure; P = process; O = outcome.
e N = number of pharmacies elegible; % = response percentage.
f Only references that were available to the expert panel are listed in the table.
g Only assessed on numerical indicators, expressing the power of the indicator. Where statistic validity was not applicable, this was counted as 1 (and presented between parentheses).
h Indicator domain.
i Only to be answered by compounding pharmacies.
j Only to be answered by pharmacies without certified quality management system (QI 9.5) because assessing this process is part of the audit.
GP = general practitioner; mg = milligram; mL/min = milliliter per minute; n/a = not available; NSAID = nonsteroidal anti-inflammatory drug; OTC = over the counter; QI = quality indicator; RAS = renin-angiotensin system; SSRI = selective serotonin re-uptake inhibitor.