PHARMACOEPIDEMIOLOGY AND PRESCRIPTION Compliance with quality prescribing indicators in terms of their relationship to financial incentives Rocío Fernández Urrusuno & Ma Carmen Montero Balosa & Pastora Pérez Pérez & Beatriz Pascual de la Pisa Received: 2 March 2013 / Accepted: 21 May 2013 # Springer-Verlag Berlin Heidelberg 2013 Abstract Objective To develop quality prescribing indicators for gen- eral practitioners (GPs) who are non-monitored and not included in pay-for-performance programs, and to deter- mine compliance with incentivized and non-incentivized indicators. Study design Descriptive cross sectional study. Setting: Aljarafe Primary Health Care Area (Andalusian Public Health Care Service, Spain), a rural and suburban area with a population of 323,857 inhabitants. Health assistance in this area is provided by 176 GPs in 37 health centers. Prescribing indicators were developed by a multidisciplinary group using a qualitative technique based on consensus. The members of the consensus group searched for updated recommendations focused on clinical evidence. Prescribing data were obtained from the computerised pharmacy records of reimbursed drugs and clinical data from the electronic clinical databases and hospital admission records. Results Fourteen indicators based on the selection of drugs of different therapeutic groups or linked to patient´s clinical information were designed. The compliance with indicators based on the selection of drugs linked to financial incentives was higher than that of indicators not linked to financial incentives. The compliance with indicators based on clinical information varied widely. Inappropriate prescribing ranged from 7 %, in the use of long-acting beta-agonists in asthma, to 86 % in the use of drugs for the prevention of osteopo- rotic fractures in young women. Conclusions This study shows better compliance by GPs with indirect and incentivized quality prescribing indicators, included in pay-for-performance programs, compared with not-incentivized indicators based on the relative use of drugs and on the appropriateness prescribing. Keywords Primary care . Quality prescribing indicators . Financial incentives Introduction General practitioners (GPs) should ensure the best use of medicines because of their direct impact on the quality of care that patients receive [1, 2]. Prescribing by GPs is one of the activities with the greatest potential to produce health benefits or to cause harm. The development of quality prescribing indicators facilitates the understanding and eval- uation of pharmaceutical prescription and provides refer- ence values that should be considered as quality standards for a good clinical practice [3–8]. Management of quality prescribing indicators can guide health authorities in their interventions to improve the efficient use of resources, to detect possible prescribing deviations, and to provide a guarantee of security in the use of drugs [8–12]. Health care providers show an increasing interest in monitoring the quality of GPs practice for the purposes of benchmarking and the distribution of financial incentives in the belief that they can accelerate improvements in the quality of care. The authors guarantee that this paper will not be published elsewhere in any language without the consent of the copyright owners, that the rights of third parties will not be violated, and that the publisher will not be held legally responsible should there be any claims for compensation. R. Fernández Urrusuno (*) : M. C. Montero Balosa Service of Pharmacy, Aljarafe-Sevilla Norte Primary Health Care Area, Distrito Sanitario Aljarafe; Avda de las Américas s/n, 41927 Mairena del Aljarafe, Seville, Spain e-mail: rocio.fernandez.sspa@juntadeandalucia.es P. Pérez Pérez Andalucian Patient Safety Observatory, Agency for Health Care Quality, Aljarafe Primary Health Care Area, Seville, Spain B. Pascual de la Pisa Family and Communitary Practice, Aljarafe-Sevilla Norte Primary Health Care Area, Seville, Spain Eur J Clin Pharmacol DOI 10.1007/s00228-013-1542-4