Short-lived Effects of a Formulary on Anti-infective Prescribing–the Need for Continuing Peer Review?

Abstract

Because of the introduction of indicative drug budgets in the UK and their likely association with prescribing from a drug formulary, we have studied the effect of the introduction without continued reinforcement of a voluntary practice formulary on antimicrobial prescribing in a group practice. Detailed prescribing feedback for two matched periods before and after the launch of the Northern Ireland Faculty of the Royal College of General Practitioners practice formulary was compared. The parameters chosen were adherence to the formulary, generic prescribing and costs. A slight increase in prescriptions dispensed (3.5%) was observed between the two periods but prescribing costs increased by 32%. There was a 5.9% fall in the number of prescriptions for formulary agents following the launch of the formulary and a major increase (60%; P < 0.01) in the use of non-formulary antimicrobials particularly penicillins and tetracyclines. It was concluded that the high level of formulary prescribing prevalent during the production of the formulary was not maintained following its launch probably because of the lack of reinforcement.

Variation in requests for imaging investigations by general practitioners: A multilevel analysis

“…The latter finding, which probably resulted from general discussions of and reflections on practice behaviour in such group practices, is in line with earlier findings on prescription behaviour and test ordering. [23][24][25] Compared with their colleagues in singleperson practices, GPs within a group practice can more easily discuss and, perhaps, solve test ordering problems that they encounter, such as demands for tests by patients and the changing of guidelines. However, it is possible that GPs who are more critical when it comes to test ordering prefer to work in a group practice.…”

Variation in test ordering behaviour of GPs: professional or context-related factors?

“…This finding, which probably results from general discussions of and reflections on practice behaviour in such group practices, is in line with earlier findings related to prescription behaviour. [24][25][26] Finally, at the regional level, it was particularly the level of experience with a problem-oriented test ordering form that appeared to have a large impact on the numbers of tests ordered. It is not so much the influence of the order form itself that is surprising, but rather the magnitude of this effect.…”

The quality of prescribing in general practice

“…There is evidence that there has been drift away from the use of common antibiotics towards occasional agents [11], and this is a trend which can only be countered by continuing audit of compliance with rational prescribing [6].…”

“…Conversely, no drug is without its risks and patients need to be protected from those they do not need, or when another product could achieve the same result in a safer or more convenient form. Furthermore, prescribers need to think rationally about therapeutics, and consider carefully those drugs they will include in their personal, formal or de facto, formularies [4,5], as well as being aware that formularies require continuing attention if they are to be effective [6].…”