gms | German Medical Science

20th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

05.12. - 06.12.2013, Düsseldorf

Prescribing indicators: an OECD initiative with first results from Germany

Verordnungsindikatoren: erste Ergebnisse aus Deutschland zu einer OECD-Initiative

Meeting Abstract

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Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 20. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Düsseldorf, 05.-06.12.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. Doc13gaa31

doi: 10.3205/13gaa31, urn:nbn:de:0183-13gaa315

Published: November 25, 2013
Published with erratum: December 12, 2013

© 2013 Selke et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Background: The OECD has some tradition in collecting patient safety indicators (PSI) across countries [1], [2]. Recently, a new initiative was started to compare quality of primary health care by collecting prescribing quality indicators (PQI) [3]. First a concept of valid quality indicators had to be developed and comparable databases had to be identified. This first collection of PQI focusses on the treatment of diabetes type 2 (due to the increase of its prevalence and need to improve the management of treatment), on medication safety (due to hints of inadequate prescribing of benzodiazepines and drugs for elderly patients) and on the use of antibiotics (due to the challenge of resistance).

Aim: The aim of the study is to present the results of this first set of OECD-PQI for Germany and to compare these results with other countries.

Materials and Methods: As data we used all reimbursed prescriptions (n=251 mill.) of all patients (24.5 mill.) insured with AOK, one of the main sickness funds in Germany. The calculation of the indicators was done according to the OECD Guideline for international comparison. The year of observation is 2011.

The following PQIs are analysed:

1a) Adequate use of cholesterol lowering treatment in diabetic patients, addressing possible undertreatment;

1b) first choice antihypertensives for diabetic patients; Diabetic patients were identified by chronic use of glucose regulating medication, i.e. ≥ 270 DDD/year.

2a) long term use (≥365 DDD) and 2b) high use (≥1.5 DDD/day) of benzodiazepines (N05BA, N05CD) as well as

2c) long acting benzodiazepine use in the elderly population;

3a) antibiotic (J01) use per 100 inhabitants;

3b) the proportion of second choice antibiotics (cephalosporins, quinolones) to the overall use of antibiotics (J01).

Results: In Germany 50% of all diabetic patients (identified by antidiabetic prescriptions) received at least one prescription of a cholesterol lowering drug (PQI 1a) and 90% received the first choice antihypertensive medication (ACE-inhibitor or AT II antagonist) (PQI 1b).

Long term use of benzodiazepines has been observed in 4.8 per 1000 (PQI 2a), high use in 1.6 per 1000 elderly patients (2b). 33 of 1000 elderly patients received long acting benzodiazepines (2c).

The treatment prevalence of antibiotics amounts to 34.3% (PQI 3a), with the highest prevalence rate in the youngest age group 0–9 y with 45.8%. 30% of all antibiotic DDDs were issued for cephalosporins and quinolones (PQI 3b)

Data on regional variance of the PQI and results from other countries will be available until the conference.

Conclusion: In Germany, as in many other countries, there is already a long tradition concerning the use of quality indicators for optimizing drug prescribing and treatment in the context of quality management and quality circles for primary health care physicians [4], but there is only limited national agreement on useful indicators (cf. AQUIK [5] or indicators in the National Disease Management Guidelines). Besides, no level of optimum (reference) is known, therefore benchmarking between different physicians/regions/countries is necessary to evaluate the performance of prescribing. A prerequisite for the acceptance of an indicator is a strong relation between the process described by the indicators and an improved outcome.


OECD. Health at a Glance: Europe 2012, OECD Publishing. 2012. DOI: 10.1787/9789264183896-en External link
Drösler SE, Romano PS, Tancredi DJ, Klazinga NS. International Comparability of Patient Safety Indicators in 15 OECD Member Countries: A Methodological Approach of Adjustment by Secondary Diagnoses. Health Serv Res. 2012;47(1pt1):275-92. DOI: 10.1111/j.1475-6773.2011.01290.x External link
Directorate for Employment, Labour, and Social Affairs Health Committee. Health Care Quality Indicators. Quality Indicators based on data about prescribing] of medication in primary health care; Opportunities for international Comparison. (DELSA/HEA/HCQ(2012)1)
Szecsenyi J, Bröge B, Stock J. QiSA: Das Qualitätsindikatorensystem für die ambulante Versorgung. AOK Bundesverband, AQUA-Institut. Berlin: Kompart-Verlagsgesellschaft; 2009.
AQUIK-Indikatorensatz. Available from: External link


The presentation of results concerning long term use, high use and use of long acting benzodiazepines had been revised. By mistake, the results had been presented in percent instead of per mill.