INFLUENCES OF PRACTICE CHARACTERISTICS ON PRESCRIBING IN FUNDHOLDING AND NON-FUNDHOLDING GENERAL PRACTICES - AN OBSERVATIONAL STUDY

Objective-To investigate the variation in prescribing among general pr actices by examining the contribution to this variation of fundholding , training status, partnership status, and the level of deprivation in the practice population and to investigate the extent to which fundho lding has been responsible for any changes in prescribing. Design-Anal ysis of prescribing data (PACT) for the years 1990-1 (before fundholdi ng) and 1993-4 (after fundholding). Use of multiple linear regressions to investigate the variation among practices in total prescribing cos ts (net ingredient cost per prescribing unit), prescribing volume (ite ms per 1000 prescribing units), and mean cost per item in each of the two years and also the change in these variables between years. Settin g-Former Mersey region. Subjects-384 practices. Results-The models dev eloped explained the variation in cost per item (43% of variation expl ained for 1990-1, 38% for 1993-4) and prescribing volume (34% for 1990 -1, 38% for 1993-4) better than the variation in total prescribing cos ts (3% for 1990-1, 7% for 1993-4). The models developed to explain the change in these variables between years did not explain more than 10% of the variation. Most of the explained variation in the change in to tal prescribing costs was accounted for by fundholding. Of the pound 3 .71 saved by first wave fundholders compared with non-fundholders poun d 3.57 was attributable to fundholding alone. Conclusion-In neither ye ar did fundholding make a major contribution to the variation in presc ribing behaviour among practices, which was better explained by depriv ation, training status, and partnership status, but it did seem largel y responsible for differences in the rise of total prescribing costs b etween fundholders and non-fundholders.