Prescribing In General Practice Research Articles

Evidence‐based prescribing in general practice: the practice‐based pharmacist's role

Pharmacists are increasingly working in UK general practices, presenting an opportunity for practice teams to benefit from their additional professional skills and comprehensive knowledge of medicines. This article examines how pharmacists are helping to reduce inappropriate and inequitable prescribing in general practice and suggests ways in which their contribution can be optimised.

Glaucoma treatment and deprivation: time-series analysis of general practice prescribing in England.

Despite advances in glaucoma management, topical eyedrop treatment has been paramount, with prostaglandin analogues (PGAs) being first-line agents. While late presentation is linked with deprivation, there is no recent research examining associations between deprivation and prescribing within primary care. To explore PGA prescribing in general practice over a 6-year timeline, assessing associations with deprivation. Analysis of NHS Business Services Authority (NHSBSA) data for general practice prescribing in England from April 2016-March 2022. Glaucoma treatments by GP prescribers were extracted, identifying ~9.11-9.58 million prescriptions/annum. Data were linked to Index of Multiple Deprivation (IMD) quintiles of GP practices. Crude rates per 1000 population were calculated using population data from NHS Digital. Time-series analyses facilitated comparison in prescribing nationally and in deprived areas. Autoregressive Integrated Moving Average (ARIMA) modelling facilitated measurement of synchrony between time series using cross correlation. PGAs and fixed combination eyedrops accounted for approximately two-thirds of glaucoma-related prescribing. Prescriptions per month increased slightly over a 6-year timeline, but rates per 1000 population reduced in 2020-2021 during the COVID-19 pandemic. The number of PGA prescriptions dispensed in deprived areas was lower than all other quintiles. Cross-correlation analysis indicates a lag of ~12 months between average PGA prescribing nationally versus more deprived areas. The rate of PGA prescribing in primary care was substantially lower in deprived versus affluent areas, with delayed uptake of PGAs in more deprived areas of ~12 months. Further research is needed to explore reasons for this discrepancy, permitting strategies to be developed to reduce unwarranted variation.

Temporal trends in antibiotic prescribing and serious and nonserious infections in children presenting to general practice: a registry-based longitudinal cohort study of 162 507 individuals.

It is crucial to understand the trends in paediatric antibiotic prescribing and serious and nonserious infections to improve antibiotic prescribing practices for children in ambulatory care. Assessing trends in paediatric antibiotic prescribing and infection incidence in general practice from 2002 to 2022. In this retrospective cohort study using INTEGO network data from 162 507 patients in Flanders (Belgium), we calculated antibiotic prescribing rates and proportions alongside incidence rates of serious and nonserious infections, stratified by age (0-1, 2-6, 7-12 years) and municipality. We performed autoregressive moving average time-series analyses and seasonality analyses. From 2002 to 2022, antibiotic prescribing rate decreased significantly: 584/1000 person-years (PY) (95% CI 571-597) to 484/1000PY (95% CI 478-491); so did antibiotic overall prescribing proportion: 46.3% (95% CI 45.1-47.6) to 23.3% (95% CI 22.9-23.7) (59.3% amoxicillin and 17.8% broad spectrum). Prescribing proportions dropped significantly for nonserious (45.6% to 20.9%) and increased for serious infections (64.1% to 69.8%). Proportions significantly dropped for acute suppurative otitis media (74.7% to 64.1%), upper respiratory tract infections (44.9% to 16.6%), bronchitis/bronchiolitis (73.6% to 44.1%) and acute tonsillopharyngitis (59.5% to 21.7%), while significantly increasing for pneumonia (65.2% to 80.2%). Nonserious and serious infection incidence rates increased from 785/1000PY and 34.2/1000PY to 1223/1000PY and 64.1/1000PY, respectively. Blood and CRP testing proportions increased significantly. Antibiotic prescribing in general practice for children declined from 2002 to 2022. Further targeted antibiotic stewardship initiatives are needed to reduce the use of broad-spectrum antibiotics and antibiotic prescribing for conditions such as otitis media and bronchitis/bronchiolitis.

Selection of proxy indicators estimating the appropriateness of antibiotic prescriptions in general practice: a national consensus procedure in France.

GPs are responsible for more than 70% of outpatient antibiotic prescriptions in France. Metrics are important antibiotic stewardship tools that can be used to set targets for improvement and to give feedback to professionals and stakeholders. The primary objective of the present study was to select a set of proxy indicators (PIs) based on 10 previously developed PIs, to estimate the appropriateness of antibiotic prescriptions by GPs. The secondary objective was to evaluate the clinimetric properties of the selected PIs. A RAND-modified Delphi consensus procedure was conducted with a multidisciplinary panel of stakeholders. This procedure consisted of two successive online surveys with a consensus meeting in between. Clinimetric properties (measurability, applicability and potential room for improvement) were evaluated for the PIs selected through the consensus procedure, using 2022 Regional Health Insurance data. Seventeen experts participated in the first-round survey and 14 in the second-round. A final set of 12 PIs was selected. Among the 10 initial PIs, 3 were selected without modification and 7 were modified and selected. Moreover, two newly suggested PIs were selected. Ten of the 12 PIs presented good clinimetric properties. The 12 selected PIs cover the main situations responsible for inappropriate and unnecessary use of antibiotics in general practice. These PIs, easily calculable using routinely collected health insurance reimbursement data, might be used to give feedback to prescribers and stakeholders and help improve antibiotic prescriptions in primary care.

Overprescribing of potentially harmful medication: an observational study in England's general practice.

Overprescribing of potentially harmful medication in UK general practice has a complex association with socioeconomic deprivation. To assess trends in general practice prescribing of five high-risk medications and their relationship with deprivation. An observational study was conducted using general practice data from three English regions with varied sociodemographic factors: West Yorkshire and Harrogate (WY), Black Country and West Birmingham (BC), and Surrey and East Sussex (SE). Practice-level prescribing data were obtained from 2016-2021 for five drug classes: opioids, hypnotics, gabapentinoids, non-steroidal anti-inflammatory drugs (NSAIDs), and antibacterials. Prescribing trends were demonstrated using a linear model. Reduction in NSAID, opioid, hypnotic and antibacterial prescriptions, and the increase in gabapentinoid prescriptions, were significant at each financial year time period. Index of Multiple Deprivation (IMD) was positively associated with all drug classes except antibacterials, which showed a positive association when incorporating the interaction term between IMD and age.When adjusting for IMD and population, region was independently associated with prescribing rate. Compared with WY, IMD had a smaller association with prescribing in BC for NSAIDs (coefficient = -0.01578, P = 0.004) and antibacterials (coefficient = -0.02769, P = 0.007), whereas IMD had a greater association with prescribing in SE for NSAIDs (coefficient = 0.02443, P<0.001), opioids (coefficient = 0.08919, P<0.001), hypnotics (coefficient = 0.09038, P<0.001), gabapentinoids (coefficient = 0.1095, P<0.001), and antibacterials (coefficient = 0.01601, P = 0.19). The association of socioeconomic deprivation with overprescribing of high-risk medication in general practice varies by region and drug type. Geographical location is associated with overprescribing, independent of socioeconomic status.

Patient demographics and psychotropic medication prescribing in Australian general practices: pre- and during COVID-19 pandemic

Patient demographics and psychotropic medication prescribing in Australian general practices: pre- and during COVID-19 pandemic

CHIME-GP trial of online education for prescribing, pathology and imaging ordering in general practice – how did it bring about behaviour change?

BackgroundThere is a need for scalable clinician education in rational medication prescribing and rational ordering of pathology and imaging to help improve patient safety and enable more efficient utilisation of healthcare resources. Our wider study evaluated the effectiveness of a multifaceted education intervention for general practitioners (GPs) in rational prescribing and ordering of pathology and imaging tests, in the context of Australia’s online patient-controlled health record system, My Health Record (MHR), and found evidence for measurable behaviour change in pathology ordering among participants who completed the educational activities. This current study explored the mechanisms of behaviour change brought about by the intervention, with a view to informing the development of similar interventions in the future.MethodsThis mixed methods investigation used self-reported questionnaires at baseline and post-education on MHR use and rational prescribing and test ordering. These were analysed using multi-level ordinal logistic regression models. Semi-structured interviews pre- and post-intervention were also conducted and were analysed thematically using the COM-B framework.ResultsOf the 106 GPs recruited into the study, 60 completed baseline and 37 completed post-education questionnaires. Nineteen participants were interviewed at baseline and completion. Analysis of questionnaires demonstrated a significant increase in confidence using MHR and in self-reported frequency of MHR use, post-education compared with baseline. There were also similar improvements in confidence across the cohort pre-post education in deprescribing, frequency of review of pathology ordering regimens and evidence-based imaging. The qualitative findings showed an increase in GPs’ perceived capability with, and the use of MHR, at post-education compared with baseline. Participants saw the education as an opportunity for learning, for reinforcing what they already knew, and for motivating change of behaviour in increasing their utilisation of MHR, and ordering fewer unnecessary tests and prescriptions.ConclusionsOur education intervention appeared to provide its effects through providing opportunity, increasing capability and enhancing motivation to increase MHR knowledge and usage, as well as rational prescribing and test ordering behaviour. There were overlapping effects of skills acquisition and confidence across intervention arms, which may have contributed to wider changes in behaviour than the specific topic area addressed in the education.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12620000010998) (09/01/2020).

Digital Public Health in Ireland

Abstract Before COVID-19 Ireland had a very limited digital health infrastructure. There are no unique health identifiers, and it is common for patients to be on the books of multiple providers, be that general practitioners, or hospital waiting lists, so capacity analysis beyond actual hospital admissions, is very limited. There are separate systems used to manage child development and vaccine delivery. Infectious disease reporting is done, feeding into a 25-year-old central system. General practice (GP) is the only sector that uses electronic records widely, which support a messaging system, to return hospital test results to the GP. Prescriptions were commonly handwritten on paper or typed, specifically on three-layer fan-fold paper, using obsolete printers for fully state-funded prescriptions. The patient transferred these to the pharmacist. COVID-19 shook this system to the foundation. It became necessary to set up contact tracing systems and vaccination systems for the entire population. These were built very quickly as free-standing systems. In addition, hospital activity data, which had been typically available a month after the date of discharge, was needed daily to manage bed capacity. Pharmacists had to receive prescriptions online, and e-prescribing was brought in. All of this worked and often worked well. More embarrassingly, as COVID-19 case numbers rose, the recording system did not scale, and reported case numbers were substantially too low for a time. Now that the acute pandemic response is over, very little has changed. Hospital prescriptions are still paper-based, although GP prescriptions use the new system. Contact tracing is shut down, and the vaccination system is scaled back. There is still no health identifier in use. Few of the lessons of the pandemic response have been learned, and the opportunity to make more significant changes in public health systems has been missed. A ‘good’ crisis was wasted.

Audit and feedback interventions involving pharmacists to influence prescribing behaviour in general practice: a systematic review and meta-analysis.

Pharmacists, as experts in medicines, are increasingly employed in general practices and undertake a range of responsibilities. Audit and feedback (A&F) interventions are effective in achieving behaviour change, including prescribing. The extent of pharmacist involvement in A&F interventions to influence prescribing is unknown. This review aimed to assess the effectiveness of A&F interventions involving pharmacists on prescribing in general practice compared with no A&F/usual care and to describe features of A&F interventions and pharmacist characteristics. Electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, (Social) Science Citation Indexes, ISI Web of Science) were searched (2012, 2019, 2020). Cochrane systematic review methods were applied to trial identification, selection, and risk of bias. Results were summarized descriptively and heterogeneity was assessed. A random-effects meta-analysis was conducted where studies were sufficiently homogenous in design and outcome. Eleven cluster-randomized studies from 9 countries were included. Risk of bias across most domains was low. Interventions focussed on older patients, specific clinical area(s), or specific medications. Meta-analysis of 6 studies showed improved prescribing outcomes (pooled risk ratio: 0.78, 95% confidence interval: 0.64-0.94). Interventions including both verbal and written feedback or computerized decision support for prescribers were more effective. Pharmacists who received study-specific training, provided ongoing support to prescribers or reviewed prescribing for individual patients, contributed to more effective interventions. A&F interventions involving pharmacists can lead to small improvements in evidence-based prescribing in general practice settings. Future implementation of A&F within general practice should compare different ways of involving pharmacists to determine how to optimize effectiveness.PRISMA-compliant abstract included in Supplementary Material 1.

Prescriptions of antihypertensive drugs are influenced by the characteristics of general practitioners and their patients: a cross-sectional study in Normandy, France.

Hypertension is associated with significant cardio-vascular morbi-mortality. However, hypertension control is low, especially in France. The reasons influencing general practitioners' (GPs) prescription of antihypertensive drugs (ADs) remains unclear. This study aimed at assessing the influence of GP and patient characteristics on AD prescriptions. A cross-sectional study based on a sample of 2165 GPs was realized in Normandy (France) in 2019. The ration of AD prescription to overall prescription volume was calculated for each GP and allowed the definition of a 'low or high AD prescriber'. Associations of this AD prescription ratio with GP's age, gender, practice location, number of years of practice, number of consultations, number and age of registered patients, patients' income and number of patients with a chronic condition were assessed using univariate and multivariate analysis. Low prescriber GPs were 51.3±11.2 years-old and were mainly women (56%). In the multivariate analysis, low prescribers were associated with urban practice (OR: 1.47, 95%CI: 1.14-1.88), GP's younger age (OR: 1.87, 95%CI: 1.42-2.44), patient's younger age (OR: 3.39, 95%CI: 2.77-4.15), more patient consultations (OR: 1.33, 95%CI: 1.11-1.61), lower income patients (OR: 1.44, 95%CI: 1.17-1.76) and fewer diabetes mellitus patients (OR: 0.72, 95%CI: 0.59-0.88). Prescriptions of ADs are influenced by the characteristics of GPs and their patients. In future work, a more detailed assessment of all components of the consultation (in particular home blood pressure monitoring use) is necessary to explain AD prescription in general practice.

PS-BPP05-4: PRESCRIPTIONS OF ANTIHYPERTENSIVE DRUGS ARE INFLUENCED BY THE CHARACTERISTICS OF GENERAL PRACTITIONERS AND THEIR PATIENTS

Background: Hypertension is associated with significant cardiovascular morbimortality. However, hypertension control is low, especially in France. The reasons influencing general practitioners (GP) prescription of antihypertensive drugs (AD) remains unclear. This study aimed at assessing the influence of GP and patient characteristics on AD prescriptions. Methods: A cross-sectional study based on a sample of 2,165 GPs working with French national health insurance was realized in Normandy (region of France) in 2019. Only GPs meeting the criteria for full-time GP practice were included. The ration of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP and permited the low-high AD prescriber definition. Associations of this AD prescription ratio with GP age, gender, practice location, number of years of practice, number of home visits and consultations, number and age of registered patients, patient income and number of patient with a chronic condition were assessed using univariate and multivariate analysis. Results: The low prescribers GPs were 51.3 ± 11.2 year-old and were mainly women (56%) and practiced in urban context (53%). They prescribed less antihypertensives drugs (4% vs 8%, p &lt; 0.001) and had more low-income patients (6% vs 4%, p &lt; 0.001). In the multivariate analysis, low prescribers were associated to urban practice (OR: 1.47, 95%CI: 1.14;1.88), GP younger age (OR: 1.87, 95%CI:1.42;2.44), patients younger age (OR: 3.39, 95%CI: 2.77;4.15), more patients consultations (OR: 1.33,95%CI: 1.11;1.61), more low-income patients (OR: 1.44, 95%CI: 1.17;1.76) and less diabetes mellitus patients (OR: 0.72, 95%CI:0.59;0.88). Conclusions: Our study described a profile of the typical low er AD prescriber GP. In future work, a more detailed assessment of all components of the consultation (in particular home blood pressure monitoring use) is necessary to explain AD prescription in general practice.

Use of path analysis to predict changes to community pharmacy and GP emergency hormonal contraception (EHC) provision in England

ObjectivesIn 2014/2015, 46% of community pharmacies were commissioned by local authorities to provide emergency hormonal contraception (EHC) free without prescription in England. Commissioning EHC services influences EHC prescribing from General...

Throat infections and use of streptococcal antigen test and antibiotic treatment in general practice; a web-based survey

Objective The aim of this study was to investigate the use of streptococcal antigen tests and antibiotic prescription in general practice in Norway in relation to the national guidelines for sore throat. Design This study was based on a web-based survey. Setting Norwegian general practice. Subjects 4700 members of the Norwegian College of General Practice received the survey by E-mail. Main outcome measures General practitioner (GP) adherence to national guidelines. Results In total, 807 GPs responded and were included in the study. According to the guidelines, 20% and 30% of the GPs would perform unnecessary streptococcal antigen testing when presented with mild and severe infections respectively, while 52% would not perform the test at moderate infection. Phenoxymethylpenicillin was recommended by 95% of the GPs. Conclusion In this survey of self-selected GPs, we identified some non-adherence to National guidelines for streptococcal antigen testing and antibiotic prescribing. However, when antibiotic treatment was offered, the correct antibiotics were prescribed. Key points Norwegian guidelines for diagnosis and treatment of throat infections include the use of Centor criteria as a clinical tool to limit the unnecessary use of antibiotics. In this web-based survey, we investigated the use of streptococcal antigen tests and antibiotic prescription in general practice in relation to the national guidelines. •Streptococcal antigen tests were not always performed according to Norwegian guidelines, causing inappropriate antibiotic prescribing. •National guidelines were followed in the choice of antibiotics for sore throat.

Evolution of benzodiazepine receptor agonist prescriptions in general practice: A registry-based study.

BackgroundContrary to most European guidelines, benzodiazepine receptor agonists (BZRA) are often used continuously at a low dosage, being the most common form of long-term use. In Belgium, BZRA use is monitored by analyzing self-report data about medication use in the last 24 h. This method provides insufficient insight into the terms of use of these psychoactive drugs.AimTo describe trends in BZRA prescribing in Flanders, Belgium, between 2000 and 2019.Design and settingPopulation-based trend analysis and a case-control study for the year 2019 were done with data from a morbidity registry in general practice.MethodsRepeated cross-sectional and joinpoint regression analyses revealed trends in sex- and age-standardized prescription rates among adult patients (18+).ResultsOverall, BZRA prescriptions increased. The highest overall increase was found among male patients 18–44 years old, with an average annual percentage change of 2.5 (95% CI: 0.9, 4.3). Among 65+ female patients, a decrease was found since 2006, with an annual percentage change of −0.7 (95% CI: −1.3, −0.1). In 2019, 12% of registered patients received minimally one prescription, long-term use was observed in 5%, back pain was the most common morbidity significantly associated with a rise in BZRA prescriptions, and zolpidem was the most prescribed BZRA (22%).ConclusionDespite some statistically significant decreasing trends, an overall increase in BZRA prescriptions was observed throughout the 19-year study period, especially among long-term users of 18–44 years and 65-plus. Zolpidem became the most prescribed BZRA and warrants more attention.

Unlicensed medicine prescribing in general practice

An unlicensed medicine is a medication that has not been approved for use by the Medicines and Healthcare products Regulatory Agency. In England, unlicensed medicines account for just under 1% of all community prescriptions, and thus, prescribers will encounter them relatively regularly during their working life. It is important to know the evidence-based guidelines about unlicensed medicines before prescribing them.

Folic acid and methotrexate use and their association with COVID-19 diagnosis and mortality: a case–control analysis from the UK Biobank

ObjectiveTo determine if methotrexate or folic acid prescription was associated with differential risk for COVID-19 diagnosis or mortality.DesignCase–control analysis.SettingThe population-based UK Biobank (UKBB) cohort.ParticipantsData from 380 380 UKBB participants with...

Opioid prescribing in general practice: an Australian cross-sectional survey

BackgroundPrescribed opioid doses > 100 mg oral morphine equivalent (OME) and/or co-prescribing of sedating psychoactive medications increase the risk of unintentional fatal overdose. We describe general practice encounters where opioids are prescribed and examine high-risk opioid prescribing.MethodsThe 2006–2016 BEACH study data, a rolling national cross-sectional survey of randomly selected GPs, was analysed.ResultsOpioid prescribing increased 2006–2007 to 2015–2016, however, this plateaued across the latter half-decade. From 2012–2016 3,897 GPs recorded 389,700 encounters and at least one opioid was prescribed at 5.2%. Opioid encounters more likely involved males, those 45–64 years, concession card holders and the socioeconomically disadvantaged. GPs more likely to prescribe opioids were 55 years or older, male, Australian graduates, and in regional and remote areas. The most common problems managed with opioids involved chronic non-cancer pain. One-in-ten opioid prescribing episodes involved high-risk doses and 11% involved co-prescription of sedating psychoactive medications. Over one-third of GPs provided other (non-pharmacological) interventions at encounters with opioid prescriptions.ConclusionsOnly 5% of GP encounters involved an opioid prescription. Of concern, were: prescribing for chronic non-cancer pain, potentially high-risk opioid encounters where > 100 OME daily dose was prescribed, and/or there was co-prescription of sedating psychoactive medication. However, approximately one-in-three opioid prescribing encounters involved non-pharmacological interventions.

Antibiotics prescribing practices for sore throat in a sub-urban primary care clinic

&lt;p&gt;&lt;strong&gt;Background and Objective:&lt;/strong&gt; Antimicrobial resistance (AMR) is one of the serious health problems in Pakistan. Excessive use of antibiotics during pandemics has aggravated AMR; hence, rational use in the future is even more important to consider and implement. Clinical audits on antibiotic prescribing in general practice can help improve antimicrobial stewardship. This study was designed as an audit to evaluate if the antibiotics prescribed for Streptococcus pharyngitis at a sub-urban primary care center in Pakistan were in line with the standard and latest guidelines.&lt;br /&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective audit was carried out at the primary care center located at Nainsukh, Lahore, Pakistan during 1 month period. Both adult and pediatric patients (above 3 years of age) presenting with upper respiratory tract infections were included in the study. A total of 48 consultation cards were identified using International Classification of Diseases 10 coding. The antibiotic prescribing practice of primary care physicians was evaluated against the Modified Centor Criteria (MCC) which was used as a standard. A score of &amp;le;3 required no antibiotic whereas a score of &amp;ge; 3 needed a same-day antibiotic prescription for sore throat.&lt;br /&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 28 (58.3%) patients presenting with MCC of &amp;le;3 and were not given antibiotics. Antibiotic prescriptions issued on the day of presentation were n = 20; however, only n = 7 (35%) met the standard criteria, i.e., MCC score of &amp;ge;3 and among these patients, penicillin remained the first choice with 71% patients receiving amoxicillin, while 28% received co-amoxiclav.&lt;br /&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Antibiotic stewardship is lacking among general physicians working at the sub-urban primary health care center in Lahore city. Clinical audits, as a part of clinical governance, may help improving the quality of care provided to the community by the regional primary health care physicians.&lt;/p&gt;

PRESCRIPTIONS OF ANTIHYPERTENSIVE DRUGS ARE INFLUENCED BY THE CHARACTERISTICS OF GENERAL PRACTITIONERS AND THEIR PATIENTS: A CROSS-SECTIONAL STUDY IN NORMANDY (FRANCE)

Objective: Hypertension is associated with significant cardio-vascular morbi-mortality. However, hypertension control is low, especially in France. The reasons influencing general practitioners’(GP) prescription of antihypertensive drugs (AD) remains unclear. This study aimed at assessing the influence of GP and patient characteristics on AD prescriptions. Design and method: A cross-sectional study based on a sample of 2,165 GPs working with French national health insurance was realized in Normandy (region of France) in 2019. Only GPs meeting the criteria for full-time GP practice were included. The ration of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP and permited the “low-high AD prescriber’’ definition. Associations of this AD prescription ratio with GP’s age, gender, practice location, number of years of practice, number of home visits and consultations, number and age of registered patients, man patient income and number of patient with a chronic condition were assessed using univariate and multivariate analysis. Results: The low prescribers GPs were 51.3 ± 11.2 year-old and were mainly women (56%) and practiced in urban context (53%). They prescribed less antihypertensives drugs (4% vs 8%, p &lt; 0.001) and had more low-income patients (6% vs 4%, p &lt; 0.001). In the multivariate analysis, low prescribers were associated to urban practice (OR: 1.47, 95%CI: 1.14;1.88), GP’s younger age (OR: 1.87, 95%CI: 1.42;2.44), patients younger age (OR: 3.39, 95%CI: 2.77;4.15), more patients consultations (OR: 1.33, 95%CI: 1.11;1.61), more low-income patients (OR: 1.44, 95%CI: 1.17;1.76) and less diabetes mellitus patients (OR: 0.72, 95%CI: 0.59;0.88). Conclusions: Our study described a profile of the typical lower AD prescriber GP. In future work, a more detailed assessment of all components of the consultation (in particular home blood pressure monitoring use) is necessary to explain AD prescription in general practice.

TRIPLE ANTIHYPERTENSIVE THERAPY TYPE AND USE IN FRENCH GENERAL PRACTICE AND CARDIOLOGY IN 2021

Objective: Blood pressure control in France leaves room for improvement. Analysis of the data from the 2015 ESTEBAN study found treatment to be insufficient, with disproportionate use of monotherapies. The 2016 French National Authority for Health (HAS) guidelines emphasise the importance of logical treatment titration giving preference in primary prevention to a triple therapy combining a renin-angiotensin system blocker, a thiazide diuretic and a dihydropyridine. The impact of these guidelines on the prescription of triple therapies has not been studied in France. Design and method: Data from the IQVIA Longitudinal Patient Database (LPD) France were used. LPD France is a permanent observatory to which a nationally representative panel of physicians – including general practitioners (GPs) (n = 1200) and community cardiologists (n = 100) – contribute anonymised electronic medical records (EMR). The analysis included all antihypertensive treatment prescriptions from July 2020 to June 2021, which were then extrapolated to the entire population of mainland France. Results: In 2021, a total of 2 455 065 patients had received a triple therapy. A figure that accounted for 17.4% of the patients seen by a GP (n = 2 016 689) and 19.0% of the hypertensive patients followed by a cardiologist (n = 438 376). The most common (&gt;5%) triple therapy combinations are given in the table. The ‘standard’ triple therapy recommended by the guidelines accounted for only 24.7% of the prescriptions in general practice. The prescriptions made in the cardiology and general practice settings have more similarities than differences. Conclusions: These findings confirm not just the insufficient use of triple therapies, but also their misuse, with the overrepresentation of the beta-blockers class not always justified by preferential indications. These observations should call into question both the quality of the guidelines’ dissemination and the continuing education of the primary care practitioners for this disease.