INVESTIGATION OF WHETHER ON-SITE GENERAL-PRACTICE COUNSELORS HAVE AN IMPACT ON PSYCHOTROPIC-DRUG PRESCRIBING RATES AND COSTS

Background. Counselling services are now widespread within general pra ctice. Although the cost-effectiveness of such services has yet to be fully investigated, benefits could include a reduction in prescribing of psychotropic drugs and of other drugs. Aim. A study set out to dete rmine whether practices with counsellors differed from those without i n terms of their prescribing rates and costs of psychotropic drugs. Me thod. Prescribing analyses and cost (PACT) level two data reports for the quarter to November 1991 ending January 1992, as appropriate, were sought from 354 practices with counsellors and a matched sample of 21 6 practices without counsellors which had participated in a previous n ational survey of counselling in general practice. The drug groups exa mined were: hypnotics and anxiolytics; antidepressants; analgesics; al l central nervous system drugs; and all drugs apart from central nervo us system drugs. For each group of drugs, the numbers of prescribed it ems, total prescribing costs, and costs per item were expressed as a p roportion of the practice's number of prescribing units (that is, the age-adjusted number of registered patients) and as a percentage of the average for similar practices in its family health services authority . Practice characteristics were compared between practices with an on- site counsellor and those without. Practices with and without counsell ors were compared with respect to their prescribing indicators. Result s. PACT reports were obtained from 214 practices (response rate 38%) - 126 with counsellors and 88 without. Practices with counsellors and p ractices without counsellors were well matched in terms of location, l ist size, proportion of elderly patients, training and fundholding sta tus, and number of health promotion clinics. No significant differenc es were found between practices with and without counsellors in the pr escribing indicators for any group of psychotropic drugs examined or f or central nervous system drugs as a whole. Conclusion. There were no appreciable differences found in this study between practices with and without counsellors in terms of psychotropic drug prescribing rates o r costs. The reasons for this are unclear; more indepth studies of ind ividual counselling services are required.