Ward Paul R, Noyce Peter R, St Leger Antony S
Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
Int J Equity Health. 2005 Feb 8;4(1):3. doi: 10.1186/1475-9276-4-3.
There is a small, but growing body of literature highlighting inequities in GP practice prescribing rates for many drug therapies. The aim of this paper is to further explore the equity of prescribing for five major CHD drug groups and to explain the amount of variation in GP practice prescribing rates that can be explained by a range of healthcare needs indicators (HCNIs). METHODS: The study involved a cross-sectional secondary analysis in four primary care trusts (PCTs 1-4) in the North West of England, including 132 GP practices. Prescribing rates (average daily quantities per registered patient aged over 35 years) and HCNIs were developed for all GP practices. Analysis was undertaken using multiple linear regression. RESULTS: Between 22-25% of the variation in prescribing rates for statins, beta-blockers and bendrofluazide was explained in the multiple regression models. Slightly more variation was explained for ACE inhibitors (31.6%) and considerably more for aspirin (51.2%). Prescribing rates were positively associated with CHD hospital diagnoses and procedures for all drug groups other than ACE inhibitors. The proportion of patients aged 55-74 years was positively related to all prescribing rates other than aspirin, where they were positively related to the proportion of patients aged >75 years. However, prescribing rates for statins and ACE inhibitors were negatively associated with the proportion of patients aged >75 years in addition to the proportion of patients from minority ethnic groups. Prescribing rates for aspirin, bendrofluazide and all CHD drugs combined were negatively associated with deprivation. CONCLUSION: Although around 25-50% of the variation in prescribing rates was explained by HCNIs, this varied markedly between PCTs and drug groups. Prescribing rates were generally characterised by both positive and negative associations with HCNIs, suggesting possible inequities in prescribing rates on the basis of ethnicity, deprivation and the proportion of patients aged over 75 years (for statins and ACE inhibitors, but not for aspirin).
有一小部分但数量在不断增加的文献强调了许多药物治疗在全科医生（GP）诊疗处方率方面存在的不平等现象。本文旨在进一步探讨五大冠心病药物组的处方公平性，并解释一系列医疗保健需求指标（HCNIs）能够解释的全科医生诊疗处方率的变化量。方法：该研究涉及对英格兰西北部四个初级医疗信托（PCTs 1 - 4）进行横断面二次分析，包括132家全科医生诊所。为所有全科医生诊所制定了处方率（每35岁以上注册患者的平均每日用量）和HCNIs。采用多元线性回归进行分析。结果：多元回归模型解释了他汀类药物、β受体阻滞剂和苄氟噻嗪处方率22% - 25%的变化。对于血管紧张素转换酶（ACE）抑制剂，解释的变化略多一些（31.6%），而对于阿司匹林，解释的变化则多得多（51.2%）。除ACE抑制剂外，所有药物组的处方率与冠心病医院诊断和治疗程序呈正相关。55 - 74岁患者的比例与除阿司匹林外的所有处方率呈正相关，而阿司匹林的处方率与75岁以上患者的比例呈正相关。然而，他汀类药物和ACE抑制剂的处方率除了与少数族裔患者的比例呈负相关外，还与75岁以上患者的比例呈负相关。阿司匹林、苄氟噻嗪以及所有冠心病药物综合处方率与贫困程度呈负相关。结论：尽管HCNIs解释了约25% - 50%的处方率变化，但这在初级医疗信托和药物组之间存在显著差异。处方率通常与HCNIs既有正相关又有负相关，这表明在基于种族、贫困程度以及75岁以上患者比例（对于他汀类药物和ACE抑制剂，但不包括阿司匹林）的处方率方面可能存在不平等现象。
