General practice fundholding: observations on prescribing patterns and costs using the defined daily dose method (original) (raw)
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GP fundholding and the costs of prescribing: further results
Journal of Public Health, 1997
Background An earlier paper published in this journal suggested that fundholding practices in Lincolnshire had managed to constrain the growth in their prescribing costs more successfully than had non-fundholders, largely on the basis of restricting the number of items prescribed per patient. At that time, insufficient data were available to explore the impact of a change in status from non-fundholding to fundholding on prescribing behaviour.
2000
Objective To identify how some general practices have low growth in prescribing costs relative to other practices. Design Observational study. Setting Trent region of England. Participants 162 general practices: 54 with low growth in prescribing costs, 54 with average increases in costs, and 54 with large increases in costs. Main outcome measures Changes in prescribing costs in therapeutic categories in which it has been suggested that savings can be made. Results There were significant differences between the three groups of practices in terms of their changes in prescribing costs for almost all the variables studied. For the group of practices with lowest growth in costs the most important factors were reducing numbers of prescription items and costs per item; relatively low growth in the costs of "new and expensive" drugs; increasing generic prescribing; and reducing costs for modified release products. This group of practices did not increase costs as much as the others for lipid lowering drugs (P = 0.012) and hormone replacement therapy (P = 0.007). The practices with the greatest increases in costs had particularly large increases for proton pump inhibitors, selective serotonin reuptake inhibitors, and modified release products. Compared with the other groups these practices had larger increases in costs for "expensive hospital initiated drugs" (P = 0.009).
Factors influencing the variation in GMS prescribing expenditure in Ireland
Health Economics Review, 2016
Background: Pharmaceutical expenditure growth is a familiar feature in many Western health systems and is a real concern for policymakers. A state funded General Medical Services (GMS) scheme in Ireland experienced an increase in prescription expenditure of 414 % between 1998 and 2012. This paper seeks to explore the rationale for this growth by investigating the composition (Anatomical Therapeutic Chemical (ATC) Group level 1 & 5) and drivers of GMS drug expenditure in Ireland in 2012. Methods: A cross-sectional study was carried out on the Health Service Executive-Primary Care Reimbursement Service (HSE-PCRS) population prescribing database (n = 1,630,775). Three models were applied to test the association between annual expenditure per claimant whilst controlling for age, sex, region, and the pharmacology of the drugs as represented by the main ATC groups. Results: The mean annual cost per claimant was €751 (median = €211; SD = €1323.10; range = €3.27-€298,670). Age, sex, and regions were all significant contributory factors of expenditure, with gender having the greatest impact (β = 0.107). Those aged over 75 (β =1.195) were the greatest contributors to annual GMS prescribing costs. As regards regions, the South has the greatest cost increasing impact. When the ATC groups were included the impact of gender is diluted by the pharmacology of the products, with cardiovascular prescribing (ATC 'C') most influential (β = 1.229) and the explanatory power of the model increased from 40 % to 60 %. Conclusion: Whilst policies aimed at cost containment (co-payment charges; generic substitution; reference pricing; adjustments to GMS eligibility) can be used to curtail expenditure, health promotional programs and educational interventions should be given equal emphasis. Also policies intended to affect physicians' prescribing behaviour include guidelines, information (about price and less expensive alternatives) and feedback, and the use of budgetary restrictions could yield savings in Ireland and can be easily translated to the international context.
Average daily quantities: a tool for measuring prescribing volume in England
Pharmacoepidemiology and Drug Safety, 2000
No perfect unit exists for measuring prescribing volume, because of the limitations of the prescription item and the De®ned Daily Dose system. A speci®c English and easily understandable unit was thought desirable to allow discussions in the ®eld with doctors about aspects of their prescribing. An expert group was therefore established to produce appropriate volume units (Average Daily Quantities, ADQs) for important drug groups, based on DDDs, average prescribed daily doses, and any available information on therapeutic equivalence. This system will be a useful tool for discussions with doctors concerning their prescribing. It is of some value for researchers performing drug utilization studies and studies on prescribing in England. The ADQ values will be reviewed regularly to ensure that changes in licensed doses, actual prescribing patterns, and DDDs are re¯ected, and that new drugs can be included.
Informing Prescribing Allocations at District Level in England
Journal of Health Services Research & Policy, 1997
Objectives: To derive a predictive model based on the morbidity, demographic and socio-economic characteristics of district populations to explain variations in prescribing costs in England. Method: Inter-relations between morbidity, demographic, socio-economic, general practice supply characteristics and net ingredient cost per age, sex and temporary resident originated prescribing unit (ASTRO-PU) were explored statistically for 90 districts in England using 1994 cost data. The possibility of mutual inter-relationship between ‘supply’ and ‘demand’ was examined; then the associations between a range of factors and prescribing costs were estimated using ordinary least squares regression and the predictive power of the possible models was systematically examined. Results: Whilst there was a relatively weak relationship between the supply factors that were measured, there did not appear to be any reciprocal relationship. Three parsimonious models estimated using ordinary least squares ...