Prescribing In England Research Articles

When is it cost-effective to change the behavior of health professionals?

Because of the workings of health care systems, new, important, and cost-effective treatments sometimes do not become routine care while well-marketed products of equivocal value achieve widespread adoption. Should policymakers attempt to influence clinical behavior and correct for these inefficiencies? Implementation methods achieve a certain level of behavioral change but cost money to enact. These factors can be combined with the cost-effectiveness of treatments to estimate an overall policy cost-effectiveness. In general, policy cost-effectiveness is always less attractive than treatment cost-effectiveness. Consequently trying to improve the uptake of underused cost-effective care or reduce the overuse of new and expensive treatments may not always make economic sense. In this article, we present a method for calculating policy cost-effectiveness and illustrate it with examples from a recent trial, conducted during 1997 and 1998, of educational outreach by community pharmacists to influence physician prescribing in England.

Generic prescribing in England reached all-time high in 2000

Generic prescribing in England reached all-time high in 2000

Trends in primary care antibiotic prescribing in England 1994–1998

To investigate the changing decisions to prescribe antibiotics as manifest in the patterns of prescriptions dispensed in England, and to investigate antibiotic prescribing in different types of practice. Antibiotic prescribing data and practice characteristics collected for every practice in England for the years 1994/5-1997/8. Morbidity data for common infections was also obtained from published sources. Antibiotic prescribing was related to practice characteristics, with high prescribing in deprived and single-handed practices in particular. There was a fall in antibiotic prescribing in all types of practice of practice over the period of the study. Morbidity data from other sources shows a fall in diagnosed morbidity from some infectious diseases over the same period. There were no differences in choice of antibiotic in different types of practice. The fall in antibiotic prescribing is universal across all kinds of practices and is possibly related to the fall in diagnoses. It is uncertain whether this reflects true morbidity.

Cardiovascular events in users of sildenafil: results from first phase of prescription event monitoring in England

Sildenafil is used to treat erectile dysfunction, and prescription on the NHS is restricted. We are conducting a study of prescription event monitoring for sildenafil in England, the first phase...

Average daily quantities: a tool for measuring prescribing volume in England

No perfect unit exists for measuring prescribing volume, because of the limitations of the prescription item and the Defined Daily Dose system. A specific English and easily understandable unit was thought desirable to allow discussions in the field with doctors about aspects of their prescribing. An expert group was therefore established to produce appropriate volume units (Average Daily Quantities, ADQs) for important drug groups, based on DDDs, average prescribed daily doses, and any available information on therapeutic equivalence. This system will be a useful tool for discussions with doctors concerning their prescribing. It is of some value for researchers performing drug utilization studies and studies on prescribing in England. The ADQ values will be reviewed regularly to ensure that changes in licensed doses, actual prescribing patterns, and DDDs are reflected, and that new drugs can be included. Copyright (c) 2000 John Wiley & Sons, Ltd.

Survey of amphetamine prescribing in England and Wales

A survey was undertaken of senior medical specialists in drug dependence in England and Wales, enquiring about their attitudes and practices concerning the prescription of amphetamines to dependent users. Of the 149 who replied, 60% saw a role for amphetamine prescribing, with 46% currently doing so. Of those who did not prescribe, 32% would like to have done so. Respondents often did not know if general practitioners in their area were prescribing amphetamines. Many could not estimate the percentage of injecting amphetamine users in their area. There was a wide range in the dosage of amphetamine prescribed with a mean maximum of 66 mg. There was agreement about entry criteria for prescribing programmes and also on ways of monitoring those receiving amphetamine. Our results indicate that amphetamine prescribing is widespread in England and Wales although there is little scientific evidence for its efficacy. We have developed some guidelines for good practice, drawing on our own and others' experience.

Most written prescriptions in England are generic

Most written prescriptions in England are generic

National and regional characteristics of methadone prescribing in England and Wales: local analyses of data from the 1995 national survey of community pharmacies

The ‘British system’ permits a greater degree of freedom than any other national drug policy system, with all medical practitioners having the authority, for example, to prescribe methadone (in oral or injectable forms) to drug misusers in the treatment of their dependence. Nevertheless, little is known about how this clinical freedom is exercised, and how constant or variable the practice may be across the country. Methadone is the most frequently prescribed substitute opiate in the treatment of opiate addiction - 98% of all opiate prescriptions being dispensed by community pharmacists to addicts in 1995. The number of opiate addicts to whom methadone was prescribed increased fourfold between 1988 and 1995. We report on the characteristics of methadone prescribing nationally and on the extent of regional variations in this practice across England and Wales, drawing on data on 3693 methadone prescriptions. The distribution curve for daily dose was skewed towards lower doses, with 68% of prescriptions bein...

Can the fatal toxicity of antidepressant drugs be predicted with pharmacological and toxicological data?

Antidepressant drugs are among the most common drugs involved in fatal poisoning and large variations between antidepressant drugs have been noted. Despite the fact that a large number of studies have calculated a fatal toxicity index (FTI) for antidepressants, no serious attempts have been made to compare the differences in fatal toxicity against known pharmacological and toxicological differences in receptor affinity. It is potentially from such data that screening of drugs during their pre-clinical development can be facilitated. We examined correlations between the FTI and noradrenaline (norepinephrine)/serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibition selectivity, the dose that is lethal to 50% of animals (LD50), lipid solubility, and antagonist activity at cholinergic, histaminergic, alpha-adrenergic and gamma-aminobutyric acid (GABA)A receptors or sodium and potassium channel blocking effects. We obtained data on the number of fatal poisonings between 1983 and 1992 in England and Wales caused by a single antidepressant drug from the Department of Health in the UK. This number was divided by the number of prescriptions in England for these drugs over this time to derive a FTI of deaths per million prescriptions. The highest FTIs were for amoxapine, viloxazine, desipramine and dothiepin. Lofepramine, paroxetine and fluoxetine had very low FTIs. Using Poisson regression, there was a significant positive relationship between the FTI of antidepressant drugs and their lethal toxicity in animals, and measures of their cardiac effects. The relative noradrenaline/serotonin reuptake inhibition, lipid solubility and their potency at histamine H1, muscarinic and alpha 1-adrenergic receptors had no substantial association with the FTI. Limited data suggest that some cardiac effects and potency as a GABAA antagonist may be important predictors of significant toxicity. Further data using standardised bio-assays are needed to compare the direct cardiac effects of antidepressants. Thus, the best current pre-clinical indicator of fatal toxicity in humans is the LD50 in animal studies. Clearly, there are humane and practical reasons for developing a better pre-clinical indicator of toxicity in overdose for this rapidly expanding group of drugs.

Specific therapeutic group age-sex related prescribing units (STAR-PUs): weightings for analysing general practices' prescribing in England

To derive cost comparators for prescribing by English general practitioners in eight specific therapeutic groups, based on age-sex related weightings, and to confirm, from a new dataset, earlier age-sex weightings for overall prescribing (ASTRO-PUs). Calculations based on one year's prescribing data from selected practices using AAH Meditel software, held on MediPlus by Intercontinental Medical Statistics (IMS, UK and Ireland), and research practices using VAMP software, held on the General Practice Research Database. 112 English practices with 739,672 patients and 510 British practices with 3,126,570 patients. Cost based weightings for 18 age-sex groups and for temporary residents for eight leading specific therapeutic groups and for prescribing overall. The two datasets were similar in age distribution and in the way that prescription numbers were distributed by age-sex band in each therapeutic group. The cost based weightings for specific therapeutic groups showed great variation in the use of these groups for patients in different age-sex groups. When these weightings were applied to the prescribing of practices in two family health services authorities they differed in their power to predict prescribing costs: for cardiovascular and gastrointestinal drugs predictive power was particularly high; for drugs for infections it was particularly low, since these are widely used at all ages and for both sexes. Cost based weightings for overall prescribing derived from the IMS data were similar to those of the ASTRO-PU system even though they were derived by different methods from different datasets. The weightings (STAR-PUs) offer a sound basis for cost comparisons at the therapeutic group level. Cost-based weightings for overall prescribing derived from the IMS data were reassuringly similar to those of the existing ASTRO-PU system.

Present-day methadone prescribing in England.

The “United Kingdom Statistics of Drug Addiction and Criminal Offences Involving Drugs” (published by the Home Office) gives the following data as of 31st December 1969: of the total number of 1466 known drug addicts (namely, addicts to hard drugs), 499 were taking heroin, and more than double that number, namely 1011, were taking methadone (either alone or with other drugs). A footnote explains that “as a result of a deliberate policy adopted by Hospital Clinics in the treatment of heroin addiction, of weaning patients from heroin on to methadone, methadone has supplanted heroin as the drug most commonly used by addicts.” What is meant by the phrase “most commonly used by addicts” is probably, “most commonly prescribed to addicts,” as, of course, the number of abusers or addicts buying “Chinese heroin” or English heroin or methadone on the black market is unknown. There is, in fact, a certain amount of black market dealing in these and other drugs going on.