THE SCALE OF REPEAT PRESCRIBING

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 te rm, and have been small in scale, but it is clear that repeat prescrib ing has increased over the past 25 years with a recent acceleration du e to computerization. Managing the process has become more important a s the scale has increased. A computer related standard definition woul d provide linkage with other information held on the practice computer about the recipients. Using aggregated practice data the current nati onal picture could be ascertained for comparison with that of individu al practices. At practice level if will be less important simply to kn ow the scale of repeat prescribing than to make analyses of repeat pre scribing of particular drug groups, and of the age and sex groups of t he recipients. This could provide a valuable basis for improving clini cal care. Aim. To estimate the present scale of repeat prescribing - o verall, for specific age-sex groups, and for some specific drug groups ; to provide a much needed standard definition of repeat prescribing n ow inevitably related to computer procedures; and to show how clinical ly valuable audits might be simply generated as reports by a practice computer. Method. Repeat prescriptions were defined as those printed b y a practice computer from its repeat prescribing program over a perio d of one year. Prescribing data for a year, with demographic details o f the patients involved, were obtained for 115 practices from the IMS MediPlus database. These practices had 750 390 patients and issued 5.8 2 million prescriptions during the year. Analyses were made of the ove rall percentages of items and costs due to repeats; the percentage of patients receiving repeats, by age and sex; the percentage receiving r epeats, by age and sex, in areas of particular concern; and percentage repeat prescribing in 46 drug groups. Results. No differences were fo und between fundholding and non-fundholding practices, or between disp ensing and non-dispensing practices. The ratio of acute to repeat pres criptions in the practices was stable over four years. Repeats account ed for 75% of all items and 81% of prescribing costs; 48.4% of all pat ients were receiving a repeat prescription. Many drugs, including hypn otics, were given almost entirely as repeats. The percentage of repeat s increased with patients' age, from 36% in the 0-4 year age group to more than 90% for patients aged 85 and over. If was higher overall for males than for females, though this relationship did not hold for old er 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 patien ts involved were being given adequate clinical care, but it permits an alyses at practice level that can indicate where special attention may be required. It could usefully be adopted as the much-needed standard definition.