The ‘top 100’ drugs and classes in England: an updated ‘starter formulary’ for trainee prescribers

Audi, Salma; Burrage, Daniel; Lonsdale, Derrick; Pontefract, Sarah; Coleman, Jamie J.; Hitchings, Andrew W.; Baker, Emma H.

doi:10.1111/bcp.13709

Cited by 47 publications

(55 citation statements)

References 5 publications

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“…However, in England, the 100 most commonly prescribed drugs have been remarkably consistent over the last decade and the core list of most commonly prescribed drug groups has remained stable. 24 As demonstrated in our study, a pre-emptive multigene panel could impact on multiple prescribing decisions throughout a patient's life. However, 1 recognised barrier to the implementation of pharmacogenomics into healthcare services is the lack of evidence of clinical utility.…”

Section: Study Strengths and Limitationsmentioning

confidence: 67%

Longitudinal exposure of English primary care patients to pharmacogenomic drugs: An analysis to inform design of pre‐emptive pharmacogenomic testing

Kimpton

Carey

Threapleton

et al. 2019

Brit J Clinical Pharma

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To investigate the longitudinal exposure of English primary care patients to pharmacogenomic drugs to inform design of pre-emptive testing. Methods: Sixty-three drugs were identified with dosing guidelines based on variants of 19 pharmacogenes in the Pharmacogenomics Knowledgebase on 01 September 2018. Prescribing of these pharmacogenomic drugs between 1993 and 2017 was summarised for a sample of 648 141 English patients aged 50-99 years on 01 January 2013, registered with Clinical Practice Research Datalink practices during 2011-12. Exposure of patients to pharmacogenomic drugs retrospectively (2, 10, 20 y) and prospectively (5 y) was described. Results: During 2011-12, 58% of patients were prescribed at least 1 pharmacogenomic drug, increasing to 80% over the previous 20 years. Multiple exposure was common, with 47% patients prescribed ≥2 pharmacogenomic drugs and 7% prescribed ≥5 pharmacogenomic drugs over the next 5 years. The likelihood of exposure to pharmacogenomic drugs increased with age, with 89% patients ≥70 years prescribed at least 1 pharmacogenomic drug over the previous 20 years. Even among those aged 50-59 years, 71% were prescribed at least 1 pharmacogenomic drug over the previous 20 years. The pharmacogenomic drugs prescribed to the most patients were for pain relief, gastroprotection, psychiatric and cardiovascular conditions. Three pharmacogenes (CYP2D6, CYP2C19 and SLCO1B1) accounted for >95% pharmacogenomic drugs prescribed. Conclusions: In primary care patients, exposure to pharmacogenomic drugs is extremely common, multiplicitous and has commenced by relatively early adulthood. A small number of pharmacogenes account for the majority of drugs prescribed. These findings could inform design of pre-emptive pharmacogenomic testing for implementation in primary care.

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Section: Study Strengths and Limitationsmentioning

confidence: 67%

Longitudinal exposure of English primary care patients to pharmacogenomic drugs: An analysis to inform design of pre‐emptive pharmacogenomic testing

Kimpton

Carey

Threapleton

et al. 2019

Brit J Clinical Pharma

Self Cite

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“…Nonetheless, both drug classes are among the top 25 most prescribed medications in the hospital setting in the UK. 5 …”

Section: Introductionmentioning

confidence: 99%

Trends in acid suppressant drug prescriptions in primary care in the UK: a population-based cross-sectional study

et al. 2020

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ObjectiveTo examine proton pump inhibitor (PPI) and histamine-2 receptor antagonist (H2RA) prescribing patterns over a 29-year period by quantifying annual prevalence and prescribing intensity over time.DesignPopulation-based cross-sectional study.SettingMore than 700 general practices contributing data to the UK Clinical Practice Research Datalink (CPRD).ParticipantsWithin a cohort of 14 242 329 patients registered in the CPRD, 3 027 383 patients were prescribed at least one PPI or H2RA from 1 January 1990 to 31 December 2018.Primary and secondary outcome measuresAnnual prescription rates were estimated by dividing the number of patients prescribed a PPI or H2RA by the total CPRD population. Change in prescribing intensity (number of prescriptions per year divided by person-years of follow-up) was calculated using negative binomial regression.ResultsFrom 1990 to 2018, 21.3% of the CPRD population was exposed to at least one acid suppressant drug. During that period, PPI prevalence increased from 0.2% to 14.2%, while H2RA prevalence remained low (range: 1.2%–3.4%). Yearly prescribing intensity to PPIs increased during the first 15 years of the study period but remained relatively constant for the remainder of the study period. In contrast, yearly prescribing intensity of H2RAs decreased from 1990 to 2009 but has begun to slightly increase over the past 5 years.ConclusionsWhile PPI prevalence has been increasing over time, its prescribing intensity has recently plateaued. Notwithstanding their efficacy, PPIs are associated with a number of adverse effects not attributed to H2RAs, whose prescribing intensity has begun to increase. Thus, H2RAs remain a valuable treatment option for individuals with gastric conditions.

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“…The development of a ‘starter’ formulary for trainee prescribers has been an important step, as during training, students may be exposed to varied prescribing practices. [8, 10, 11] However, even more experienced prescribers, depending on their pharmacology training,[8] could also benefit from rationalising their personal formulary to enhance quality of prescribing and potentially reduce errors. In total, approximately 600 medicines featured in the DU90% of at least one practice, representing about half of medications included.…”

Section: Discussionmentioning

confidence: 99%

“…[9] Mitigating this risk of confusion is one basis for developing a core drug list for undergraduate and postgraduate prescribing education in the UK. [10, 11] Some countries have implemented restricted formularies or essential medicines lists on this basis, such as the ‘Wise List’ in Sweden and local formularies in the UK,[9, 12, 13] to make it facilitate clinicians in prescribing the most effective, safe and appropriate medications for their patients. [14]…”

Section: Introductionmentioning

confidence: 99%

How many medications do doctors in primary care use? An observational study of the DU90% indicator in primary care in England.

Chiedozie

Murphy

Fahey

et al. 2020

Preprint

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Aim: To apply the DU90% indicator (the number of unique drugs which make up 90% of a doctor's prescribing) to GP practices prescribing in England to examine time trends, practice-level variation, and relationships with practice characteristics Method: This is an observational cohort study of all general practices in England. It utilises publicly available prescribing data from the National Health Service (NHS) Digital platform for 2013-2017. The DU90% was calculated on an annual basis for each practice based on medication BNF codes. Descriptive statistics were generated per year on time trends and practice-level variation in the DU90%. Multi-level linear regression was used to examine the practice characteristics (relating to staff, patients, and deprivation of the practice area). Results: A total of 7,623 GP practices were included. The mean DU90% ranged from 130.1 to 133.4 across study years, and variation between practices was low (with a 1.4 fold difference between the lowest and highest 5% of practices). A range of medications were included in the DU90% of virtually all practices, including atorvastatin, levothyroxine, omeprazole, ramipril, amlodipine, simvastatin and aspirin. A higher volume of prescribing was associated with a lower DU90%, while having more patients, higher proportions of patients who are female or aged 65+, higher number of GPs working in the practice, and being in a more deprived area were associated with a higher DU90%. Conclusion: GP practices typically use 130 different medications in the bulk of their prescribing. Increasing use of personal formularies may enhance prescribing quality and reduce costs.

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The ‘top 100’ drugs and classes in England: an updated ‘starter formulary’ for trainee prescribers

Cited by 47 publications

References 5 publications

Longitudinal exposure of English primary care patients to pharmacogenomic drugs: An analysis to inform design of pre‐emptive pharmacogenomic testing

Longitudinal exposure of English primary care patients to pharmacogenomic drugs: An analysis to inform design of pre‐emptive pharmacogenomic testing

Trends in acid suppressant drug prescriptions in primary care in the UK: a population-based cross-sectional study

How many medications do doctors in primary care use? An observational study of the DU90% indicator in primary care in England.

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