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Quality of prescribing in chronic kidney disease and type 2 diabetes

PhD ceremony:Ms K.P.J. (Kirsten) Smits
When:February 21, 2018
Start:16:15
Supervisors:prof. dr. P. (Petra) Denig, prof. dr. G.J. (Gerjan) Navis, prof. dr. H.J.G. (Henk) Bilo
Co-supervisor:dr. G.A. (Grigory) Sidorenkov
Where:Academy building RUG
Faculty:Medical Sciences / UMCG
Quality of prescribing in chronic kidney disease and type 2
diabetes

Quality of prescribing in chronic kidney disease and type 2 diabetes

Pharmacotherapy is a major pillar in the management of chronic diseases, such as chronic kidney disease (CKD) and type 2 diabetes (T2D). Assessment of the delivered care is important for quality improvement. The first part of this thesis describes an overview of existing quality indicators for CKD care and shows that many indicators have been proposed but only a few have been properly validated. Next, the development and validation of sixteen prescribing quality indicators (PQIs) for CKD is described, based on a Delphi expert panel study. The developed PQIs focus on the potential appropriate prescribing of antihypertensives, albumin-lowering drugs, statins and phosphate binders as well as the potential inappropriate prescribing of several other drugs. The set showed operational validity and usability in both primary and secondary care settings. The second part of this thesis describes the development and validation of twenty PQIs for T2D, again based on a Delphi expert panel study. This set assesses the prescribing of glucose-lowering drugs, antihypertensives, albumin-lowering drugs and statins, focusing on current medication treatment and medication choices, intensification of medication when needed as well as indicators on medication safety and potential overprescribing. In subsequent cohort studies, associations were found between several of the PQIs and intermediate patient outcomes, supporting their value for quality assessment and benchmarking purposes.  No associations were found between prescribing quality and quality of life in T2D patients. This thesis denotes important steps towards a better assessment of the quality of prescribing and optimal pharmacotherapy in patients with CKD or T2D.