Pringle M, Morton-Jones A
Department of General Practice, University of Nottingham.
Br J Gen Pract. 1994 Feb;44(379):53-6.
There are many factors underlying trends in prescribing levels in England.
This study set out to examine prescribing trends and their relationship with three measures of morbidity.
A study was undertaken examining the interrelations between basic prescribing parameters for the 90 family health services authorities in England for the year 1 April 1989 to 31 March 1990. The trends were examined for their associations with three factors which have been linked to morbidity levels: standardized mortality ratios, the Jarman index (through its use as a deprivation index), and unemployment rates.
Analysis revealed a strong inverse association between the number of items prescribed per patient and the net ingredient cost per item for the family health services authorities. These two factors together determined the net ingredient cost per patient. Cluster analysis was found to segregate approximately the family health services authorities geographically: the northern, urban areas of England were characterized by a high number of low cost items per patient while the southern semi-rural areas had a low number of high cost items per patient. The trend was such that the former area had a higher overall net ingredient cost per patient. Unemployment rates were the most robust determinant of the inverse trend of number of items and cost of items and were comparable with standardized mortality ratios in their individual correlations with the prescribing net ingredient cost per patient. The Jarman index was the weakest of the predictors.
The results lend support to the argument that material deprivation, associated with unemployment, is an important determinant of prescribing trends, perhaps acting through its effect on morbidity, and that the Jarman index is a poor indicator of deprivation. The analysis alone cannot, however, determine cause and effect for the apparent relationship between unemployment and prescribing.
英格兰处方开具水平的趋势受到多种因素影响。
本研究旨在考察处方开具趋势及其与三种发病率衡量指标的关系。
开展了一项研究，考察1989年4月1日至1990年3月31日英格兰90个家庭健康服务机构基本处方参数之间的相互关系。研究了这些趋势与三种已被证明与发病率水平相关的因素之间的关联：标准化死亡率、贾曼指数（用作贫困指数）和失业率。
分析显示，家庭健康服务机构每位患者的处方开具数量与每项药品的净成分成本之间存在强烈的负相关关系。这两个因素共同决定了每位患者的药品净成分成本。聚类分析发现，家庭健康服务机构大致按地理位置进行了划分：英格兰北部的城市地区每位患者的低成本药品数量较多，而南部的半农村地区每位患者的高成本药品数量较少。趋势是，前一个地区每位患者的总体药品净成分成本更高。失业率是药品数量和成本反向趋势的最有力决定因素，在与每位患者处方净成分成本的个体相关性方面与标准化死亡率相当。贾曼指数是预测能力最弱的因素。
这些结果支持了以下观点，即与失业相关的物质匮乏是处方开具趋势的一个重要决定因素，可能是通过其对发病率的影响起作用，并且贾曼指数是贫困的一个较差指标。然而，仅靠分析无法确定失业与处方开具之间明显关系的因果关系。
