Validation of the QualiPresc instrument for assessing the quality of drug prescription writing in primary health care

Abstract

Introduction Adverse events related to drug prescriptions are the main patient safety issue in primary care; however there is a lack of validated instruments for assessing the quality of prescription writing, which covers the prescriber, the patient and the drug information. Objective To develop and validate the QualiPresc instrument to assess and monitor the quality of drug prescriptions in primary care, accompanied by a self-instruction direction, with the goal of filling the gap in validated instruments to assess the quality of prescription writing. Methodology A validation study conducted in a municipality in Northeastern Brazil, based on prescriptions prepared in January 2021 by physicians assigned to 18 Basic Health Units and filed in 6 distribution/dispensing units. Four steps were covered: 1) Analysis of content validity of each indicator (relevance and adequacy); 2) Analysis of reliability via intra and inter-rater agreement of each indicator; 3) Analysis of the utility of each indicator; 4) Construction and analysis of the reliability of a weighted composite indicator based on effectiveness and safety scores for each indicator. Results Twenty-nine potential indicators were listed, but only 13 were approved for validity, reliability and usefulness. Twelve indicators were excluded because of validity (<90% validity index) and four because they were not useful in the context of the study. Three weighted composite indicators were tested, but only one was approved for reliability and usefulness. The validated instrument therefore contains 13 indicators and 1 weighted composite indicator. Conclusion This study demonstrates the validity, reliability and usefulness of QualiPresc for the evaluation of prescription writing in the context of primary care. Application to contexts such as secondary care and tertiary care requires cross-cultural adaptation and new content validity. Educators, managers and health care professionals can access QualiPresc online, free of charge, to assess performance and provide feedback involving drug prescribers.