Harris C M, Dajda R
Prescribing Research Unit, University of Leeds Research School of Medicine.
Br J Gen Pract. 1996 Nov;46(412):649-53.
Repeat prescribing has long been seen as a potential cause of poor clinical care, despite its obvious advantage to both doctors and patients. Previous studies have had no common definition of the term, and have been small in scale, but it is clear that repeat prescribing has increased over the past 25 years with a recent acceleration due to computerization. Managing the process has become more important as the scale has increased. A computer-related standard definition would provide linkage with other information held on the practice computer about the recipients. Using aggregated practice data the current national picture could be ascertained for comparison with that of individual practices. At practice level it will be less important simply to know the scale of repeat prescribing than to make analyses of repeat prescribing of particular drug groups, and of the age and sex groups of the recipients. This could provide a valuable basis for improving clinical care.
To estimate the present scale of repeat prescribing-overall, for specific age-sex groups, and for some specific drug groups; to provide a much needed standard definition of repeat prescribing, now inevitably related to computer procedures; and to show how clinically valuable audits might be simply generated as reports by a practice computer.
Repeat prescriptions were defined as those printed by a practice computer from its repeat prescribing program over a period of one year. Prescribing data for a year, with demographic details of the patients involved, were obtained for 115 practices from the IMS MediPlus database. These practices had 750390 patients and issued 5.82 million prescriptions during the year. Analyses were made of the overall percentages of items and costs due to repeats; the percentage of patients receiving repeats, by age and sex; the percentage receiving repeats, by age and sex, in areas of particular concern; and percentage repeat prescribing in 46 drug groups.
No differences were found between fundholding and non-fundholding practices, or between dispensing and non-dispensing practices. The ratio of acute to repeat prescriptions in the practices was stable over four years. Repeats accounted for 75% of all items and 81% of prescribing costs; 48.4% of all patients were receiving a repeat prescription. Many drugs, including hypnotics, were given almost entirely as repeats. The percentage of repeats increased with patients' age, from 36% in the 0-4 year age group to more than 90% for patients aged 85 and over. It was higher overall for males than for females, though this relationship did not hold for older patients.
This study gives the best available national picture of the use of repeat prescribing. The definition employed does not allow any direct conclusions to be drawn about whether the patients involved were being given adequate clinical care, but it permits analyses at practice level that can indicate where special attention may be required. It could usefully be adopted as the much-needed standard definition.
长期以来，重复开药一直被视为临床护理不佳的一个潜在原因，尽管它对医生和患者都有明显的好处。以往的研究对这一术语没有统一的定义，而且规模较小，但很明显，在过去25年里重复开药现象有所增加，最近由于计算机化而加速。随着规模的扩大，管理这一过程变得更加重要。一个与计算机相关的标准定义将与实践计算机中保存的关于接受者的其他信息建立联系。利用汇总的实践数据，可以确定当前的全国情况，以便与个别实践进行比较。在实践层面，仅仅了解重复开药的规模不如分析特定药物组以及接受者的年龄和性别组的重复开药情况重要。这可以为改善临床护理提供有价值的基础。
估计重复开药目前的总体规模、特定年龄性别组以及一些特定药物组的规模；提供一个迫切需要的与计算机程序相关的重复开药标准定义；并展示实践计算机如何简单地生成具有临床价值的审计报告。
重复处方被定义为实践计算机从其重复开药程序中在一年时间内打印出来的处方。从IMS MediPlus数据库中获取了115个实践的一年开药数据以及相关患者的人口统计学详细信息。这些实践共有750390名患者，当年开出了582万张处方。分析了重复开药的项目和成本的总体百分比；按年龄和性别接受重复开药的患者百分比；在特别关注领域按年龄和性别接受重复开药的百分比；以及46个药物组的重复开药百分比。
在持有基金的实践和不持有基金的实践之间，以及配药实践和非配药实践之间未发现差异。这些实践中急性处方与重复处方的比例在四年内保持稳定。重复开药占所有项目的75%，占开药成本的81%；所有患者中有48.4%正在接受重复处方。许多药物，包括催眠药，几乎完全作为重复开药使用。重复开药的百分比随着患者年龄的增加而上升，从0至4岁年龄组的36%上升到85岁及以上患者的90%以上。总体而言，男性的比例高于女性，不过这种关系在老年患者中不成立。
本研究给出了重复开药使用情况的最佳全国图景。所采用的定义不允许就所涉及的患者是否得到充分的临床护理得出任何直接结论，但它允许在实践层面进行分析，以表明可能需要特别关注的地方。它可以作为迫切需要的标准定义而被有效采用。
