Ross Sarah, Macleod Mary Joan
Department of Medicine and Therapeutics, University of Aberdeen, UK.
Br J Clin Pharmacol. 2005 Sep;60(3):300-5. doi: 10.1111/j.1365-2125.2005.02414.x.
To assess the cost implications of changing prescribing patterns for antihypertensive drugs and to analyse adherence to guidelines and formulary in Grampian region over a 1 year period.
Data on all prescriptions for antihypertensive medicines between November 2001 and October 2002 were obtained from Grampian Health Board. The total quantity and cost of each drug prescribed was calculated and compared with November 1998 to October 1999. Adherence to the local formulary and 1999 British Hypertension Society guidelines for first line agents and prescribing of generic drug names were analyzed for each practice.
There was an increase in the total number of prescriptions for antihypertensive drugs from 504929 in 1998/99 to 741620 in 2001/02, and a corresponding increase in total cost from pound 4.52 million to pound 6.79 million. Increases were seen in all drug classes, particularly angiotensin II antagonists (246.27%). Adherence to the local formulary was good, with an average of 91.25% (SD 5.94%) of prescribing consistent with recommended agents. This fell to 71.70% (SD 23.10%) for angiotensin II antagonists. Prescription using generic name was related to whether the practice dispensed medication or not: the mean level of generic prescribing in dispensing practices was 75.25% and in nondispensing practices was 89.02% (mean difference 13.76 (9.27, 18.26), P < 0.001).
There was a substantial increase in prescribing volume and cost of antihypertensives between 1998/99 and 2001/02. This trend is likely to have continued, given changing targets and indications for therapy. Although practices generally showed high concordance with formulary recommendations, newer agents such as angiotensin II antagonists were less consistent, possibly related to pharmaceutical influences on prescribing. Dispensing practices were more likely to prescribe branded drugs which may reflect current reimbursement policies. Changing prescribing practices by encouraging formulary based prescribing and prescribing of generic agents may help offset the cost implications of guideline driven increases in antihypertensive drug prescribing. Education, and reviewing payment practices in dispensing and smaller practices, may also have a role.
评估抗高血压药物处方模式改变所带来的成本影响，并分析格兰扁地区在1年时间内对指南和处方集的依从性。
从格兰扁健康委员会获取2001年11月至2002年10月期间所有抗高血压药物处方的数据。计算所开每种药物的总量和成本，并与1998年11月至1999年10月的数据进行比较。分析了每个医疗机构对当地处方集以及1999年英国高血压学会关于一线药物和通用名药物处方的依从性。
抗高血压药物处方总数从1998/99年度的504929张增加到2001/02年度的741620张，总成本相应地从452万英镑增加到679万英镑。所有药物类别均有增加，尤其是血管紧张素II拮抗剂（增加了246.27%）。对当地处方集的依从性良好，平均91.25%（标准差5.94%）的处方与推荐药物一致。血管紧张素II拮抗剂的这一比例降至71.70%（标准差23.10%）。使用通用名开处方与医疗机构是否配药有关：配药医疗机构通用名处方的平均水平为75.25%，非配药医疗机构为89.02%（平均差异13.76（9.27，18.26），P<0.001）。
1998/99年至2001/02年间，抗高血压药物的处方量和成本大幅增加。鉴于治疗目标和适应症的变化，这一趋势可能仍在持续。尽管医疗机构总体上与处方集建议高度一致，但血管紧张素II拮抗剂等新型药物的一致性较低，这可能与制药行业对处方的影响有关。配药医疗机构更有可能开品牌药，这可能反映了当前的报销政策。通过鼓励基于处方集的处方和通用名药物的处方来改变处方模式，可能有助于抵消指南驱动的抗高血压药物处方增加所带来的成本影响。教育以及审查配药和小型医疗机构的支付方式也可能发挥作用。
