HOW HAS FUNDHOLDING IN NORTHERN-IRELAND AFFECTED PRESCRIBING PATTERNS- A LONGITUDINAL-STUDY

Objective: To compare prescribing patterns in general practices before and after the introduction of fundholding in April 1993 to determine whether fundholding changed prescribing patterns among practices that joined the scheme. Design: Analysis of prescribing data from the Drug Utilisation Research Unit's database for all practices in Northern Ire land during April 1989 to March 1996. Setting: Northern Ireland. Subje cts: 23 first wave fundholders, 34 second wave fundholders, 9 third wa ve fundholders, and 268 non-fundholders. Main outcome measures: Prescr ibing costs per 1000 patients, prescription items per 1000 patients, a verage cost per item, and rate of generic prescribing. Results: Prescr ibing costs and frequency increased in all groups throughout the study . Among the fundholders the rate of increase in costs after fundholdin g was significantly lower than among non-fundholders. The rate of incr ease in cost per item fell, coinciding with a significant increase in the rate of generic prescribing. However, with regard to first wave fu ndholders, their yearly increase in costs in their third year as fundh olders (1995-6) was similar to that of the non-fundholders. The earlie r practices that joined the scheme seemed to differ in some important respects from those that joined later. Conclusions: After fundholders joined the fundholding scheme their patterns of prescribing changed co mpared with those of non-fundholders: the rate of increase in costs fe ll and there was a significant rise in the rate of generic prescribing .