Preventing drug-related morbidity--determining valid indicators

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Abstract
Objective. To describe the process that is being undertaken to validate a series of indicators for preventable drug-related morbidity—originally developed in the US—for application in the UK health care system. Design. A two-round Delphi questionnaire survey after a preliminary validation of the indicators within the University of Manchester School of Pharmacy. Setting. A primary care study set in the UK. Study participants. A purposively selected sample of general practitioners with a specific responsibility for prescribing-related issues (n= 6) and pharmacists actively involved in medication review in primary care (n= 10). Main outcome measures. The establishment of consensus among the participants that an indicator reflected preventable drug-related morbidity in primary care. Results. After preliminary validation, 37 of the original 57 US indicators were retained. The Delphi panel generated 16 additional new indicators in the first round. At the end of the second round, the pre-defined level of consensus was reached for 29 indicators (19 of the US generated indicators; ten generated by the panel in the first round). Conclusions. The Delphi results highlighted differences in both the clinical perspective and, possibly, philosophical viewpoints of health professionals practising in the UK and US health care systems. Further work, located in both primary and secondary care, is now in progress to operationalize. This process will form a key part of the refining, and hence further validation, of the indicators. The future development of prospective medical-record-based indicators should facilitate a reduction in the human, clinical, and economic burden of drug-related morbidity.