Prescribing Computer audits can help GPs monitor their prescribing habits Following a decision by 2 group general practices based in a city health centre to prescribe NSAIDs in generic form from an agreed date, a computerised prescribing system was employed to monitor the effectiveness of the changeover policy. The 2 practices had an average list size of 8525 and 3185 patients over the 18-month monitoring period. Repeat prescriptions of NSAIDs were monitored for 6 months before (Period 1) and for two 6-month periods (Periods 2 and 3) after the agreed changeover date. Repeat medications were issued on request and changeovers to generics were recorded via the computer. Patients and the health centre pharmacy were advised of the prescribing policy. During the study periods 1, 2 and 3, respectively, the number of patients receiving NSAIDs was 18, 20 and 22 per 1000 registered in Practice A and 13, 17 and 15 per 1000 in Practice B, with fewer repeat prescription items per 1000 patients in Practice B than in Practice A (26 vs 48: 32 vs 54; 35 vs 61). However, in Practice A, repeat prescriptions were usually written for 1 rather than 2 or 3 months. In Practice A, proprietary formulations of piroxicam, indomethacin, naproxen, ibuprofen and diclofenac were the most frequently prescribed NSAIDs during Period 1 (all 13-15% of repeat prescriptions) and similarly these NSAIDs were most frequently prescribed during Period 2 (all about 7%) although use of generic formulations had substantially increased (from 4% to 42% of all repeat prescription items) and the number of generics used increased from 1 to 10. Following review of the results by GPs at the end of Period 2, the use of generic formulations increased during Period 3 to 64%, and generic formulations of piroxicam, ibuprofen, indomethacin, naproxen, diclofenac and aspirin (8-13% each) were the most frequently prescribed, and each more so than the proprietary equivalent. In Practice B during Period 1, 46% of repeat prescriptions were for proprietary piroxicam and 14% were for proprietary indomethacin. During Period 2, proprietary formulations still dominated (piroxicam 35%; diclofenac 15%) although use of generics increased from 1 to 11 % while the number of generic products used increased from 1 to 5. The use of proprietary formulations dominated that of generics by 4 : 1 (except for aspirin). Diclofenac (18%), piroxicam (14%) and indomethacin (11 %) in their proprietary formulations remained the most frequent prescription items during Period 3; naproxen (10 vs 1%) and ibuprofen (9 vs 7%) were more frequently prescribed as generics than as proprietary formulations. 0156·2703/88/0917-0005/0$01.00/0 © ADIS Press Changes in prescription behaviour must accommodate the patients' requirements, and the GPs involved considered therapeutic efficacy, adverse effects and dosage regimen to be more important influences than cost in generic prescription. The computerised audit appears to be an effective method of assessing GP prescribing trends. Mills KA. Steele K, Irwin WG. Family Praclice 5 40-45, No.1. 1988 ,. .. INPHARMA" 17 Sep 1988 5

Computer audits can help GPs monitor their prescribing habits

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Page 1: Computer audits can help GPs monitor their prescribing habits

Prescribing Computer audits can help GPs monitor their prescribing habits

Following a decision by 2 group general practices based in a city health centre to prescribe NSAIDs in generic form from an agreed date, a computerised prescribing system was employed to monitor the effectiveness of the changeover policy.

The 2 practices had an average list size of 8525 and 3185 patients over the 18-month monitoring period. Repeat prescriptions of NSAIDs were monitored for 6 months before (Period 1) and for two 6-month periods (Periods 2 and 3) after the agreed changeover date. Repeat medications were issued on request and changeovers to generics were recorded via the computer. Patients and the health centre pharmacy were advised of the prescribing policy.

During the study periods 1, 2 and 3, respectively, the number of patients receiving NSAIDs was 18, 20 and 22 per 1000 registered in Practice A and 13, 17 and 15 per 1000 in Practice B, with fewer repeat prescription items per 1000 patients in Practice B than in Practice A (26 vs 48: 32 vs 54; 35 vs 61). However, in Practice A, repeat prescriptions were usually written for 1 rather than 2 or 3 months. In Practice A, proprietary formulations of piroxicam, indomethacin, naproxen, ibuprofen and diclofenac were the most frequently prescribed NSAIDs during Period 1 (all 13-15% of repeat prescriptions) and similarly these NSAIDs were most frequently prescribed during Period 2 (all about 7%) although use of generic formulations had substantially increased (from 4% to 42% of all repeat prescription items) and the number of generics used increased from 1 to 10. Following review of the results by GPs at the end of Period 2, the use of generic formulations increased during Period 3 to 64%, and generic formulations of piroxicam, ibuprofen, indomethacin, naproxen, diclofenac and aspirin (8-13% each) were the most frequently prescribed, and each more so than the proprietary equivalent.

In Practice B during Period 1, 46% of repeat prescriptions were for proprietary piroxicam and 14% were for proprietary indomethacin. During Period 2, proprietary formulations still dominated (piroxicam 35%; diclofenac 15%) although use of generics increased from 1 to 11 % while the number of generic products used increased from 1 to 5. The use of proprietary formulations dominated that of generics by 4 : 1 (except for aspirin). Diclofenac (18%), piroxicam (14%) and indomethacin (11 %) in their proprietary formulations remained the most frequent prescription items during Period 3; naproxen (10 vs 1%) and ibuprofen (9 vs 7%) were more frequently prescribed as generics than as proprietary formulations.

0156·2703/88/0917-0005/0$01.00/0 © ADIS Press

Changes in prescription behaviour must accommodate the patients' requirements, and the GPs involved considered therapeutic efficacy, adverse effects and dosage regimen to be more important influences than cost in generic prescription. The computerised audit appears to be an effective method of assessing GP prescribing trends. Mills KA. Steele K, Irwin WG. Family Praclice 5 40-45, No.1. 1988 ,. ..

INPHARMA" 17 Sep 1988 5