The influence of hospital-based prescribers on prescribing in general practice

Objective: To document the influence of hospital prescribers on prescribing in general practice. Design and Participants: Five percent of members of the Irish College of Ge neral Practitioners (n = 92) prospectively recorded 40 consecutive prescrip tions. Interventions: The name, dose and amount of medicine prescribed as well as the indication for therapy, details of their practice, distribution of priv ate/GMS patients, and the number of years since qualification were recorded . The cost of individual prescriptions was calculated based on the ingredie nt cost and the number of days of treatment. This was subsequently correlat ed with the origin of the prescription. Each prescription was classified as either new or repeat. Main outcome measures and results: Of 3286 prescriptions, 69% were for the state-supported General Medical Services (GMS) patients and 31% for private patients. Repeat prescriptions constituted 51%; 49% were new prescriptions . While hospital doctors initiated only 8% of private prescriptions, they i nitiated 38% of GMS prescriptions, particularly repeat prescriptions and th ose for cardiovascular, hormonal and centrally-acting agents. Prescriptions for anti-infectives, oral contraceptives, dermatological preparations and musculoskeletal drugs were mostly initiated in general practice. The median cost for hospital-initiated GMS prescriptions (pound 5.93) was g reater than the cost of general practitioner (GP)-initiated prescriptions ( pound 3.49; p < 0.01). Prescriptions from GPs who were qualified for less t han 10 years and those with a mixed urban and rural practice were less cost ly (p < 0.05) than those issued by doctors qualified for over 10 years or w orking predominantly in an urban or rural area. These findings may also ref lect differences in patient population, morbidity and demography. Conclusions: Our study indicates that hospital-initiated prescriptions are responsible for a significant proportion, both in volume and cost of GP pre scribing.