The scale of repeat prescribing--time for an update.

BACKGROUND: The NHS spends billions of pounds annually on repeat prescriptions in primary care, but data on their extent and use is out of date. Understanding the scale of repeat prescribing and for whom it is prescribed is important for the NHS to plan services and develop policies to improve patient care. METHOD: Anonymous data on prescription numbers and practice population demographics was obtained from GP computer systems in a large urban area.Searches were conducted in November 2011 to identify the numbers of repeat items listed on individuals' repeat lists by sex and age.The proportion of all prescription items issued as repeats was identified by conducting searches on items issued as repeat and acute prescriptions. RESULTS: In the year of study 4,453,225 items were issued of which 3,444,769 (77%) were repeats (mean 13 items per patient/annum) and 1,008,456 (23%) acute prescriptions (mean 3.9 items per patient per annum). The mean number of repeat Items per patient was 1.87 (range 0.45 ages 0-9 years; 7.1 ages 80-89 years). At least one repeat medicine was prescribed to 43% of the population (range 20% for ages 0-9; over 75% for ages 60+). CONCLUSION: A significant proportion of the population receive repeat prescriptions and the proportion increases with age. Whilst the proportion of repeat items to acute items has remained unchanged over the last two decades the number of repeat prescriptions items issued has doubled (from 5.8 to 13.3 items/patient/annum). This has implications for general practice workload, patient convenience, NHS costs and risk.

The recording of drug sensitivities for older people living in care homes.

AIMS: The aims of this study were to determine the recording of drug sensitivities of elderly care home residents, to describe the nature of sensitivities and to identify and describe discrepancies in the documentation of drug sensitivity status in general practices, pharmacies and care homes. METHODS: A random sample of residents within a purposive sample of care homes (nursing and residential) was selected. A clinical pharmacist inspected the GP medical record, the medicines administration record, and the care home record for each resident to identify drug sensitivities and discrepancies between records and to describe the nature of the recorded sensitivities. RESULTS: The records of 121 residents in 31 care homes were studied. Thirty-one (26%) residents had at least one documented drug sensitivity in one of the sources inspected, with 48 sensitivities in total recorded. There was no description of the nature of the sensitivities recorded in 39/48 (81%) cases. The number of sensitivities recorded on the medicines administration record, care home record and the GP record were 3 (6%), 29 (60%) and 35 (73%), respectively. Only two sensitivities were simultaneously recorded on all three records. CONCLUSIONS: It was of concern that over 90% of drug sensitivities were not recorded on the medicines administration record which is the final checking document when administering medication. The reason for this was that the dispensing pharmacy was responsible for generating the medicines administration record; however, drug sensitivity status is seldom shared between the GP and the dispensing pharmacy. Printing sensitivities on prescriptions would help to resolve this.

Patients' views of a pharmacist-run medication review clinic in general practice.

BACKGROUND: Reviewing elderly patients' medication is a requirement of the National Service Framework for Older People. Many general practitioners have insufficient time to review patients' medications in a consultation. Pharmacist review has been offered as an alternative and this will be a new experience for many patients. AIM: To ascertain patients' views of a pharmacist-conducted medication review clinic, run in their general practice surgery. DESIGN OF STUDY: Qualitative study using focus group interviews. SETTING: General practices in Leeds Health Authority area. METHOD: Patients aged 65 years and over, who had attended a medicine review clinic, took part in focus groups that were recorded and transcribed. Units of information representing an idea were identified and similar ideas were grouped together as themes. RESULTS: Patients had a number of prior beliefs about the clinic. Most patients knew that the clinic's purpose was to review repeat medication, to find out more about their medicines, and to ask questions about efficacy and side effects. Some patients were suspicious about the purpose of the clinic but others welcomed the opportunity to have an in-depth review and an explanation of their condition and its treatment; some patients did not accept advice or were disappointed that their expectations were not fulfilled. Most patients were happy to attend a yearly review but some expressed guilt about attending the surgery too frequently. CONCLUSION: Patients who attended the medication review clinics expressed a range of views about the service. Further research into patients' and carers' opinions about medicine review is needed to inform the development of these services.