Abstract
Low-value pharmaceutical care exists in general practice. However, the extent among Dutch GPs remains unknown. To assess the prevalence of low-value pharmaceutical care among Dutch GPs. Retrospective cohort study using data from patient records. The prevalence of three types of pharmaceutical care prescribed by GPs between 2016 and 2019 were examined: topical antibiotics for conjunctivitis, benzodiazepines for non-specific lower back pain, and chronic acid-reducing medication (ARM) prescriptions. Multilevel logistic regression analysis was performed to assess prescribing variation and the influence of patient characteristics on receiving a low-value prescription. Large variation in prevalence as well as practice variation was observed among the types of low-value pharmaceutical GP care examined. Between 53% and 61% of patients received an inappropriate antibiotics prescription for conjunctivitis, around 3% of patients with lower back pain received an inappropriate benzodiazepine prescription, and 88% received an inappropriate chronic ARM prescription during the years examined. The odds of receiving an inappropriate antibiotic or benzodiazepine prescription increased with age (P<0.001), but decreased for chronic inappropriate ARM prescriptions (P<0.001). Sex affected only the odds of receiving a non-indicated chronic ARM, with males being at higher risk (P<0.001). The odds of receiving an inappropriate ARM increased with increasing neighbourhood socioeconomic status (P<0.05). Increasing practice size decreased the odds of inappropriate antibiotic and benzodiazepine prescriptions (P<0.001). The results show that the prevalence of low-value pharmaceutical GP care varies among these three clinical problems. Significant variation in inappropriate prescribing exists between different types of pharmaceutical care - and GP practices.
Highlights
We examined the prevalence of three types of pharmaceutical care, topical antibiotics for conjunctivitis, benzodiazepines for non-specific lower back pain (LBP), and chronic acid reducing medication (ARM) prescriptions, prescribed by general practitioners (GPs) between 2016-2019
Large variation in prevalence and practice variation was observed among the examined types of low-value pharmaceutical GP care
The odds of receiving an inappropriate antibiotic or benzodiazepine prescription increased with age (p
Summary
Low-value care, defined as care that is unlikely to benefit the patient given the potential harm, cost, available alternatives and patient preferences, is considered one of the most complex problems in modern healthcare. [1, 2] In an effort to support clinicians in their daily practice, professional bodies, such as the Dutch College of General Practitioners (NHG), have published more than 120 evidencebased clinical practice guidelines. [3] despite the wide distribution and promotion of these guidelines, studies show that adherence among Dutch general practitioners (GPs) could be improved. [4,5,6,7,8,9,10] Up to one third of Dutch GP pharmaceutical prescriptions could be of low-value [6]. [4,5,6,7,8,9,10] Up to one third of Dutch GP pharmaceutical prescriptions could be of low-value [6]. Obtaining insight into the prevalence of low-value prescribing is an essential first step in improving practice. [4, 19,20,21] We aimed to quantify the prevalence and variation in low-value pharmaceutical treatments among GPs by using national medical records data. Through quantification of these prescribing practices, we hope to obtain a clearer view of low-value prescribing among GPs in the Netherlands. This is a first step in addressing the specific issue of lowvalue GP prescribing. The extent among Dutch general practitioners (GPs) remains unknown
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