General practice fundholding: observations on prescribing patterns and costs using the defined daily dose method. 1993

M Maxwell, and D Heaney, and J G Howie, and S Noble
Department of General Practice, University of Edinburgh.

OBJECTIVE To compare prescribing patterns between a group of fundholding practices and a group of non-fundholding practices in north east Scotland using a method which provides more accurate statements about volumes prescribed than standard NHS statistics. METHODS The pharmacy practice division of the National Health Service in Scotland provided data for selected British National Formulary sections over two years. Each prescription issued was converted using the World Health Organisation "defined daily dose" mechanism. METHODS Six fundholding groups (nine practices) in Grampian and Tayside regions and six non-fundholding practices in Grampian. RESULTS During the past two years both fundholding and control practices reduced the volume of their prescribing for the classes of drug analysed. The unit costs of drugs in some classes, however, rose substantially, contributing to higher costs per patient. The unit costs rose more in the control practices (24%) than in the fundholding practices (11% in Tayside, 16% in Grampian). CONCLUSIONS The use of defined daily doses helped identify cost and volume trends in specific areas of prescribing in fundholding and control practices. The basis on which funds are set needs improving, and defined daily doses may prove useful for setting volume targets within drug classes for all practices, whether fundholding or not.

UI MeSH Term Description Entries
D011307 Drug Prescriptions Directions written for the obtaining and use of DRUGS. Drug Prescribing,Drug Prescription,Drug Prescribings,Prescribing, Drug,Prescribings, Drug
D005194 Family Practice A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family. Family Practices,Practice, Family,Practices, Family
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000367 Age Factors Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time. Age Reporting,Age Factor,Factor, Age,Factors, Age
D012606 Scotland The most northerly of the four countries of the United Kingdom, occupying about one-third of the island of Great Britain. The capital is Edinburgh.
D013222 State Medicine A system of medical care regulated, controlled and financed by the government, in which the government assumes responsibility for the health needs of the population. National Health Service, British,Socialized Medicine,British Health Service, National,British National Health Service,Medicine, Socialized,Medicine, State,Service, British National Health
D016527 Drug Costs The amount that a health care institution or organization pays for its drugs. It is one component of the final price that is charged to the consumer (FEES, PHARMACEUTICAL or PRESCRIPTION FEES). Cost, Drug,Costs, Drug,Drug Cost
D017723 Drug Utilization Review Formal programs for assessing drug prescription against some standard. Drug utilization review may consider clinical appropriateness, cost effectiveness, and, in some cases, outcomes. Review is usually retrospective, but some analysis may be done before drugs are dispensed (as in computer systems which advise physicians when prescriptions are entered). Drug utilization review is mandated for Medicaid programs beginning in 1993. Utilization Review, Drug,Drug Utilization Evaluation,Drug-Use Review,Evaluation, Drug Utilization,Review, Drug Utilization,Review, Drug-Use,Drug Use Review,Drug Utilization Evaluations,Drug Utilization Reviews,Drug-Use Reviews,Evaluations, Drug Utilization,Review, Drug Use,Reviews, Drug Utilization,Reviews, Drug-Use,Utilization Evaluation, Drug,Utilization Evaluations, Drug,Utilization Reviews, Drug

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