Quality indicators for pharmacist follow-up of diabetes mellitus: A RAND-modified Delphi method

Abstract

Introduction: Diabetes mellitus is a complex condition with high morbidity which requires a multidisciplinary approach including pharmacist follow-up. Within primary care medicine, quality indicators combined with audit and feedback are described as quality improvement actions which facilitate change. However, since existing guidelines regarding pharmaceutical care for people living with diabetes mellitus are not validated in Belgium, their recommendations cannot be translated into quality indicators without content validation.

Aim: We aimed to define a set of validated and pharmaceutical record extractable quality indicators, to evaluate the quality of care provided by Belgian pharmacists to people living with diabetes.

Method: We used a RAND-modified Delphi method. Recommendations from (inter)national guidelines were selected according to the SMART principle. A multidisciplinary Belgian panel (N = 12), consisting of pharmacists, general practitioners, an endocrinologist, a representative of the pharmacists' association, a population manager, a data provider representative, and two diabetes patients, assessed the appropriateness of recommendations for their use as quality indicators. Recommendations received a first preliminary classification after analysis of the median Likert scale scores, prioritization rates, and agreement. Hereafter the recommendations were discussed by the panel in an online consensus meeting. A final validation round resulted in high-potential recommendations which were converted into QIs.

Results: A total of 82 recommendations were presented to the panel, which resulted in a set of 24 high-potential recommendations that were merged and modified into 14 recommendations based on the panel members' advice. Three of these, related to influenza and pneumococcal polysaccharide vaccine delivery, and dispensing of blood glucose influencing and sugar-containing medication, could be converted into extractable quality indicators.

Conclusion: This study defines a set of 14 quality indicators - covering screening, pharmacological treatment and patient education and lifestyle management - to evaluate the quality of care provided by Belgian pharmacists to people living with diabetes. Based on this quality assessment, the necessary improvement actions can be identified, implemented, and evaluated to strive for the most optimal care provision, aligning with evidence-based recommendations.

Keywords: Delphi technique; Guideline adherence; Health evaluation mechanisms; Population health management; Quality improvement; Quality of healthcare.