HRB Centre for Primary Care Research, Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
BMJ Open. 2021 Mar 2;11(3):e043049. doi: 10.1136/bmjopen-2020-043049.
To apply the drug utilisation 90% (DU90%) indicator (the number of unique drugs which makes up 90% of a doctor's prescribing) to general practitioner (GP) practices prescribing in England to examine time trends, practice-level variation, and relationships with practice characteristics, prescribing costs and low-value prescribing.
Retrospective cohort study.
Primary care in England, using publicly available prescribing data available from the National Health Service (NHS) digital platform for 2013-2017.
All general practices in England (n=7620).
The DU90% was calculated on an annual basis for each practice based on medication British National Formulary codes. Low-value prescribing was defined using NHS 2017 guidance (including lidocaine plasters, liothyronine, omega-3 supplements). Descriptive statistics were generated per year on time trends and practice-level variation in the DU90%. Multilevel linear regression was used to examine the practice characteristics (relating to staff, patients and deprivation of the practice area).
Among 7620 practices, mean DU90% ranged from 130.0 to 131.0 across study years, and regarding variation between practices, there was a 1.4-fold difference between the lowest and highest 5% of practices. A range of medications were included in the DU90% of virtually all practices, including atorvastatin, levothyroxine, omeprazole, ramipril, amlodipine, simvastatin and aspirin. A higher volume of prescribing was associated with a lower DU90%, while having more patients, higher proportions of patients who are women or aged ≥45 years, higher number of GPs working in the practice and being in a more deprived area were associated with a higher DU90%. Practices in higher quintiles of DU90% had higher levels of low-priority prescribing and prescribing costs.
GP practices typically use 130 different medications in the bulk of their prescribing. Higher DU90% was associated with higher levels of low-priority prescribing and prescribing costs. Increasing use of personal formularies may enhance prescribing quality and reduce costs.
将药物利用 90%（DU90%）指标（构成医生处方 90%的独特药物数量）应用于英格兰的全科医生（GP）实践处方，以检查时间趋势、实践水平的变化以及与实践特征、处方成本和低价值处方的关系。
回顾性队列研究。
使用 NHS 数字平台上 2013-2017 年提供的公开处方数据，在英格兰的初级保健中。
英格兰的所有全科医生（n=7620）。
每年根据药物英国国家处方集代码为每个实践计算 DU90%。低价值处方使用 NHS 2017 年指南（包括利多卡因贴剂、左甲状腺素、欧米茄-3 补充剂）进行定义。每年根据 DU90%的时间趋势和实践水平变化生成描述性统计数据。使用多水平线性回归检查实践特征（与工作人员、患者和实践区域的贫困有关）。
在 7620 家实践中，研究年期间 DU90%的平均值在 130.0 到 131.0 之间，关于实践之间的差异，最低和最高的 5%的实践之间存在 1.4 倍的差异。几乎所有实践的 DU90%都包括阿托伐他汀、左甲状腺素、奥美拉唑、雷米普利、氨氯地平、辛伐他汀和阿司匹林等多种药物。处方量越大，DU90%越低，而患者越多、女性或≥45 岁患者比例越高、在实践中工作的全科医生人数越多、所在地区越贫困，DU90%越高。DU90%较高的实践具有更高水平的低优先级处方和处方成本。
GP 实践通常在其大部分处方中使用 130 种不同的药物。较高的 DU90%与较高水平的低优先级处方和处方成本相关。增加个人处方的使用可能会提高处方质量并降低成本。
