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J Manag Care Pharm. 2002 Sep-Oct;8(5):372-7.

Preventable drug-related morbidity indicators in the U.S. and U.K.

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The Drug Usage and Pharmacy Practice Group, School of Pharmacy and Pharmaceutical Sciences, University of Manchester, UK.



To qualitatively describe differences between a series of preventable drug-related morbidity (PDRM) indicators in the United States (U.S.) and the United Kingdom (U.K.), after transfer from the U.S. to the U.K. health care setting.


A preliminary validation was undertaken of the U.S.-derived indicators within the University of Manchester School of Pharmacy, followed by a 2-round Delphi questionnaire of a sample of general practitioners (n=6) and primary care pharmacists (n=10). The main outcome measures were (1) relevance of the U.S. indicators to U.K. primary care prescribing as determined by preliminary validation and (2) the establishment of consensus among the Delphi participants that an indicator represented PDRM.


After preliminary validation, 7 of the U.S. indicators and a part of 2 indicators were considered of insufficient relevance to take any further part in the validation process. A further 18 of the U.S.-derived indicators failed to achieve consensus as PDRMs by the U.K. Delphi panel. At the end of the validation process, 19 indicators remained.


Many of the U.S.-derived indicators lacked relevance in the U.K. due to differences in transatlantic clinical practice. In addition, there may be differences in the philosophical viewpoints of health professionals practising in the U.S. and the U.K. In practice, it is therefore inappropriate to transfer quality indicators of this nature directly from the U.S. to the U.K. However, if some form of validation process is undertaken, indicators derived in one health care setting appear to provide a very useful starting point for those developed in another.

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