An important part of health resources are spent on prescriptions for acid suppression therapy each year in Cornwall. In 1996 the cost of prescriptions for these drugs amounted to £6.15 million [Prescription Pricing Authority. Prescription analysis and cost (PACT) data. Financial year 1996, unpublished data], which represents 14% of the total prescription cost for the district and 2% of the health authority budget. In addition there has been a continuing rise in the cost associated with acid suppression drugs, due mainly to an increasing use of proton pump inhibitors ( Figure 1). This is a national trend, but it is particularly relevant in Cornwall where the cost of acid suppression therapy is above the average for England.Studies have shown that a majority of acid suppression drugs are prescribed on a repeat basis and about 80% of the cost associated with these drugs is generated by repeat prescriptions; 1, 2 a repeat prescription has been de®ned as a prescription issued without a consultation. 1 The ®nancial burden of acid suppression drugs on health resources is therefore linked to repeat prescriptions.In previous studies repeat prescription rates varied between 1% 3±5 and 4.4%, 6 but these studies were based on a small sample of practices that were not representative of all English practices. There is evidence suggesting that repeat prescriptions may lead to an inappropriate use of acid suppression drugs, in turn leading to a waste of resources and possible damage to patients' health. A recent study carried out in seven practices in Dundee 6 has shown that 44% of patients with repeat prescriptions for acid SUMMARY Background: Repeat prescriptions for acid suppression therapy represent an important burden on health care resources. Aim: To determine the prevalence of acid suppression therapy and its indications by general practitioners (GPs) in a larger sample of practices than previous studies. Method: Practices in Cornwall and the Isles of Scilly were invited to identify the number of patients on repeat prescription for acid suppression drugs in their practice, to review the indication for treatment in a sample of 50 patients, and to indicate the mode of review of these patients.

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Improvements have occurred since study*Editor-Nicholl and Turner's attempt to perform a definitive before and after study on regionalised trauma care was beset by logistical problems. 1 Firstly, ambulance workers were not empowered to bypass the surrounding hospitals, who in turn were reluctant to be bypassed during the vulnerable period of health service reforms. Secondly, similar systems were compared. The central hospitals in Stoke, Hull, and Preston are all large hospitals with neurosurgical units on site. Thirdly, data were not collected prospectively. The researchers trawled the patients' case records often years after admission. Notes from 1990 were not requested for initial examination until 1993, by which time many had been reduced and put on to microfiche.Fourthly, the local researcher was not trained on the nationally recognised injury scaling course. There were no intra-observer variability checks to confirm consistent application of scoring methods over the four years. Lastly, significant discrepancies in data accuracy were evident. When the number of direct admissions with severe trauma in 1993 were compared with those counted by the Trauma Research Group at Keele University there was a 25% difference. An outside expert scored the same patients independently and concurred with the Keele findings to within 3%.Since 1994 we have adopted a strategy to enhance data accuracy. Details on every major trauma patient are checked weekly by a senior clinician and circulated to medical and nursing staff involved in the patient's care. Data shared freely in the clinical domain acts as a two way feedback system to promote accuracy and militate against entry bias in the trauma database. The problem of data validation must be addressed nationally, especially if audit information is to be released to purchasers of health care.Nicholl and Turner's study represents at best a snapshot at the start of the development of the trauma system. Since then much progress has been made. Last year, our crude mortality in patients with severe trauma was 20%, compared with 38% in 1989-90. 2 3 The pattern of trauma deaths with many cases of potentially salvageable major haemorrhage, referred to in the Royal College of Surgeons' report, 4 5 is no longer evident: 88% of deaths after major trauma were in patients with a critical head injury or aged over 70 years.Nicholl and Turner raise important issues but further careful studies are required to serve as evidence on which to base national policy.