The scale of repeat prescribing

Abstract

Background: Repeat prescribing has long been seen as a potential cause of poor clinical care, despite its obvious advantage to both doctors and patients. Previous studies have had no common definition of the term, and have been small in scale, but it is clear that repeat prescribing has increased over the past 25 years with a recent acceleration due to computerization. Managing the process has become more important as the scale has increased. A computer-related standard definition would provide linkage with other information held on the practice computer about the recipients. Using aggregated practice data the current national picture could be ascertained for comparison with that of individual practices. At practice level it will be less important simply to know the scale of repeat prescribing than to make analyses of repeat prescribing of particular drug groups, and of the age and sex groups of the recipients. This could provide a valuable basis for improving clinical care.

Aim: To estimate the present scale of repeat prescribing-overall, for specific age-sex groups, and for some specific drug groups; to provide a much needed standard definition of repeat prescribing, now inevitably related to computer procedures; and to show how clinically valuable audits might be simply generated as reports by a practice computer.

Method: Repeat prescriptions were defined as those printed by a practice computer from its repeat prescribing program over a period of one year. Prescribing data for a year, with demographic details of the patients involved, were obtained for 115 practices from the IMS MediPlus database. These practices had 750390 patients and issued 5.82 million prescriptions during the year. Analyses were made of the overall percentages of items and costs due to repeats; the percentage of patients receiving repeats, by age and sex; the percentage receiving repeats, by age and sex, in areas of particular concern; and percentage repeat prescribing in 46 drug groups.

Results: No differences were found between fundholding and non-fundholding practices, or between dispensing and non-dispensing practices. The ratio of acute to repeat prescriptions in the practices was stable over four years. Repeats accounted for 75% of all items and 81% of prescribing costs; 48.4% of all patients were receiving a repeat prescription. Many drugs, including hypnotics, were given almost entirely as repeats. The percentage of repeats increased with patients' age, from 36% in the 0-4 year age group to more than 90% for patients aged 85 and over. It was higher overall for males than for females, though this relationship did not hold for older patients.

Conclusion: This study gives the best available national picture of the use of repeat prescribing. The definition employed does not allow any direct conclusions to be drawn about whether the patients involved were being given adequate clinical care, but it permits analyses at practice level that can indicate where special attention may be required. It could usefully be adopted as the much-needed standard definition.