Appropriate prescribing in general practice: development of the indicators

23 Indeed it has been suggested that up to 400 different prescribing indicators have been developed by the various health authorities in England and Wales (Roberts, personal communication). There are good reasons for the development of indicators. Firstly, good prescribing is an important issue in quality of care. 4 Secondly, there are costs associated with poor prescribing, including side eVects and interactions that might be avoided by more judicious practice. Thirdly, without examining general practitioners’ prescribing in the finest detail, it is necessary to have proxies to give an indication of performance. To be useful, indicators should possess several attributes. 5 For example, they should cover elements of practice that are acknowledged to be important and not simply record what is easy to measure. Ideally they should be devised with the help of general practitioners, and they should fairly reflect their eVorts to prescribe appropriately. The data on which indicators are based should be valid and reliable, and the results should be presented in a user friendly way. It should be made clear that indicators should be used for guidance: they “cannot on their own, provide ‘definitive’ evidence of success or failure and should be used to raise questions, not provide answers”. 5