PENDAHULUAN

Concerns regarding misuse of antibiotics are of interna-tional importance. Given the development of
resistance to existing antimicrobial agents and a lack of investment into new antimicrobials, it has been
estimated that one million deaths worldwide that are due to multidrug resis-tant infections could be
expected by 2025. While there are multiple factors contributing to the development of antimicrobial
resistance, increased antibiotic use and mis-use in health care is considered a contributory factor.
Prescribing indicators have been used to monitor the quality of care across a range of health systems
and contexts. Indicators are used to reward high quality care (pay for performance), guide policy
development, allocate health care resources, identify poor performance and monitor the outcome of
interventions to improve care across a range of therapeutic areas.

BAHAN DAN METODE

Drug-specific indicators focus on the volume of use of relevant antimicrobials irrespective of the
indications for which they are being prescribed, while disease-specific indicators examine prescribing for
a particular indication. Across Europe, the ESAC indicators have been used to evaluate and compare
outpatient use of antibiotics. The aim of this study was to assess the validity of a set of European quality
indicators for outpatient antibiotic use to assess prescribing quality in Australian General Practice
discussion on the appropriateness of each scenario. At the end of the discussion, each panellist was
asked to recon-sider their original rating and re-rate the scenario. Using the RAND/UCLA methodology,
the expert panel members were asked to score the validity of each indicator for measuring quality
across a number of quality domains in the Australian general practice context as well as to pro-vide
comment regarding their individual views on each indicator. We included both drug-specific and
disease-specific ESAC indicator sets in our validation, An additional drug-specific indicator commonly
used in Australia as a measure of antibiotic prescribing quality was also included. Validity was assessed
as scores for four different validity domains, i.e. for monitoring antibiotic resistance, benefit to
individual patients or value for money and valid for policymakers

HASIL

Our findings suggest that the majority of the European ESAC indicators and their associated benchmarks
are con-sidered valid for use assessing prescribing quality in Aus-tralian General Practice. However,
some indicators were considered less appropriate for monitoring a specified domain in the Australian
context, emphasising the impor-tance of local validation studies.While this study found that the
indicators were consid-ered valid for use in Australian general practice, the use of a general practitioner
expert panel is may limit the generalisability of these results to other prescribers such as infectious
disease physicians. Another limitation of this study was the lack of a second consensus round. Gener-
ally, within the RAND methodology, a two round process is undertaken whereby in round one, members
of the expert panel individually rate the appropriateness, or in this case, the validity of the indicator and
then in round 2, a facilitated meeting is held to discuss any disagree-ment. In the current validation, no
second round was undertaken as the panel disagreed only regarding the use of systemic antimicrobials
for pneumonia (indicator 28) for monitoring resistance and for providing prescriber feedback. Although
the RAND method is well accepted for deter-mining face validity, face validity is only one aspect of
validity and other aspects such as content validity, con-current validity, construct validity and predictive
validity should also be considered.

KESIMPULAN

Conclusions This study demonstrates the validity of 30 European indicators for assessing quality of
antimicrobial prescribing in general practice in a non-European setting and provides guidance regarding
acceptable benchmarks for the indicators. With international concerns regarding misuse of antibiotics
and global interest in prescribing quality, valid evidence-based antimicrobial pre-scribing indicators and
associated benchmarks are an essential tool for assessing prescribing quality.