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Variability Seen in Primary Care High-Risk Prescribing

High-risk prescription more likely in primary care patients receiving long-term drugs

WEDNESDAY, June 22 (HealthDay News) -- High-risk prescribing or potentially inappropriate prescribing of drugs in primary care patients shows considerable unexplained variation between practices, and it is more likely in patients prescribed long-term drugs, according to a study published online June 21 in BMJ.

Bruce Guthrie, M.B., B.Chir., M.R.C.P., M.R.C.G.P., Ph.D., from the University of Dundee in the United Kingdom, and colleagues investigated the prevalence and patterns of high-risk prescribing in 139,404 primary care patients defined as particularly vulnerable to adverse drug reactions because of age, comorbidity, or co-prescription. The main outcome measured was the reliability of each of 15 indicators and a composite of all 15 in distinguishing practices in terms of high-risk prescribing rates, and the characteristics of patients and practices associated with high-risk prescribing.

The investigators found that 13.9 percent of patients (19,308 patients) received at least one high-risk prescription in the previous year. This was a reasonably reliable composite indicator for measuring high-risk prescribing practice rates (reliability, > 0.7 for 95.6 percent of practices and > 0.8 for 88.2 percent). High-risk prescribing was strongly associated with the number of drugs prescribed (odds ratio, 7.90, for more than 11 long-term prescribed drugs versus zero). A four-fold variation in rates of high-risk prescribing was seen among practices, which could not be explained by the structural characteristics of the practices, after adjustment for patient characteristics.

"High-risk prescribing was much more common in patients prescribed long-term drugs," the authors write. "Significant variation between practices was not explained by patient case mix or by a range of practice structural factors."

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