Unsuspected patterns of drug utilization revealed by interrogation of a regional general practitioner prescribing database

Abstract

The classification of drugs according to the specificity of their use has been shown to reveal unsuspected patterns of GP prescribing (McGavock, 1988). The present aim was to define the frequency distribution of rate of issue and cost of prescriptions of (a) drugs used to treat proven pathology, (b) drugs used mainly to relieve symptoms, and (c) drugs like antibiotics, whose use should be specific, but which are often used presumptively. Prescribing data were retrieved from the GP prescription pricing database, specific for individual practices and at the level of the therapeutic group (e.g. hypnotics). A new microcomputer program sorted these data into categories (a), (b) and (c), and produced frequency distributions for all practices in Northern Ireland. The distributions in all three categories were unimodal, positively skewed. A seven-tenfold range in the rate of prescribing was seen in all three categories (cost showed a threefold range), between lowest and highest practices. For each practice, prescribing rate and cost in each category were displayed, with the Northern Ireland average for comparison. This revealed the emphasis placed by each practice on the use of symptomatic treatment and the doctors' tendency to use category (c) drugs. Above all, it revealed the frequency of prescribing of drugs for proven pathology (a) which, prima facie, should be directly related to the diagnoses of diseases such as diabetes, asthma and hypertension. The interpretation of these patterns for practice audit is discussed, together with problems and caveats.

Effect of a community oriented problem based learning curriculum on quality of primary care delivered by graduates: historical cohort comparison study

“…w17 We selected two additional performance indicators to test hypothesised negative effects of the transition on the quality of diagnosis and treatment. We selected the difference between disease specific prescribing rates and prescribing rates for symptom relief because higher rates of disease specific prescribing compared with symptom relief prescribing18 have been linked to diagnostic competence15 w16 and because excess use of drugs for symptom relief is associated with potentially avoidable injuries (benzodiazepines) w18 w19 and gastrointestinal bleeding (non-steroidal anti-inflammatory drugs). w20 w21 We selected the prescribing rate for contraindicated drugs because prescribing errors account for 20% of drug related adverse events and these problems are partly related to deficiencies in doctors'knowledge 19.…”

Adverse Events Associated With Prescription Drug Cost-Sharing Among Poor and Elderly Persons

“…To study the intended impact of costsharing and to evaluate the health effects of reducing drug use, we identified a subset of essential and less essential drugs for evaluation using published classifications (TABLE 1). 18,24,25 Essential drugs were defined as medications that prevent deterioration in health or prolong life and would not likely be prescribed in the absence of a definitive diagnosis. Because there was no information on indication for treatment, the second criterion was added to limit the analysis to only those people who were using drugs for which reductions in use would be expected to have an impact on health status.…”

“…26 Less essential drugs were defined as medications that may provide relief of symptoms but will likely have no effect on the underlying disease process. 25 Drugs included in the essential and less essential categories were independently identified and then rated by the 7 clinical coinvestigators. A medication was included if 6 of the 7 clinical coinvestigators agreed with the classification of the respective drug and it was insured through the RAMQ provincial health care plan.…”

Association Between Licensing Examination Scores and Resource Use and Quality of Care in Primary Care Practice

“…This is relevant because referral is the main mechanism by which patients gain access to hospital resources and expensive surgical and investigative procedures, 3 and unexplained differences in referral rates exist among primary care physicians. [40][41][42][43] Considerable variation also exists among primary care physicians in prescription rates, 12,[44][45][46][47][48][49] and it has been suspected that these differences are related to clinical competence. 50,51 In particular, higher rates of prescription of medications often used for the relief of undifferentiated symptoms 49,[52][53][54][55][56][57][58][59][60] in the elderly (eg, benzodiazepines, nonsteroidal anti-inflammatory drugs [NSAIDs], analgesics) are seen among physicians who have low rates of prescribing for disease-specific treatments (eg, hypoglycemics, cardiac medications).…”