Defining the spectrum of appropriate prescribing: implications for effective medicines management

Abstract

The key objective of clinical governance in relationship to prescribing should be to optimise the use of the evidence base for medicines to ensure that cost issues do not over-ride the quality agenda and that health gain for patients remains the focus of the prescribing agenda. As most medicines are dispensed through primary care, a key consideration is the formation of primary care groups. Prescribing Analysis and Cost (PACT) data is currently the principal method, which enable practices to monitor their prescribing and assess various issues such as identification of therapeutic sections that account for the largest proportion of spending. However practices may be targeted for intervention on the basis of their PACT data although little is known about variation in disease prevalence or patient characteristics. Patient based systems such as the General Practice Research Database (GPRD) enable consideration of such factors. We illustrate how the GPRD has been used to show that prescribing of proton pump inhibitors for uncomplicated dyspepsia and non-specific abdominal symptoms, which were outside the licensed indications, accounted for 46% of new prescribing by 1995. If this ratio of new prescriptions is carried over into repeat prescriptions nearly a half of the current national annual expenditure of £247m could be for non-specific upper gastrointestinal symptoms. While there may be valid reasons for such prescribing, the GPRD enables a greater understanding of prescribing activity than is possible with routine prescribing data, because of the link to diagnosis and this may be relevant to other therapeutic areas. Within the next five to ten years there may be further developments centring on electronic data interchange (EDI) which will be patient based and comprise complete medication profiles. In summary, there is increasing scope for evaluating the spectrum of appropriate prescribing.