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Biomedical subjects

H McGavock

Publications and source records attributed to H McGavock.

15 recordsLinked to original sources
PubMed1999

Repeat prescribing management--a cause for concern?

BACKGROUND: No existing studies of repeat prescribing management have been carried out on statistically adequate samples permitting an extrapolation of results with regard to the population of general practitioners (GPs). AIM: To provide adequate regional evidence of the quality of repeat prescribing management for the profession and its administrators, and to test a scoring system for quality assurance in repeat prescribing practice. METHOD: A semi-structured questionnaire was administered by one observer to a statistically representative population sample of Northern Ireland's general practices to investigate the extent to which they adopted recommended procedures for the management of repeat prescribing. Responses to 26 of these questions were used to score the quality of management. The subjects were a random sample of 57 practices stratified for number of partners, geographical area, and fundholding status. RESULTS: The main outcome measures were the percentage adoption of recommended procedures at the time of repeat prescription issue and at the review consultation, use of computing for repeat prescribing and the effects of fundholding; and quality assurance scores. During issue of repeats, essential checks are often omitted; the potential of computerization for improving management is often not realized. At review consultation, the opportunities for quality assurance are often missed. Fundholders manage repeat prescribing significantly better than non-fundholders, but in neither group is the mean management score exemplary. CONCLUSION: We have identified and quantified serious deficiencies in repeat prescribing management in a representative sample large enough to permit extrapolation to the regional population of GPs. In response, we have devised guidelines that GPs might use to address this problem. We have tested and proved a scoring system for repeat prescribing evaluation.

Drug Prescriptions↗
PubMed1997

How has fundholding in Northern Ireland affected prescribing patterns? A longitudinal study.

OBJECTIVE: To compare prescribing patterns in general practices before and after the introduction of fundholding in April 1993 to determine whether fundholding changed prescribing patterns among practices that joined the scheme. DESIGN: Analysis of prescribing data from the Drug Utilisation Research Unit's database for all practices in Northern Ireland during April 1989 to March 1996. SETTING: Northern Ireland. SUBJECTS: 23-first wave fundholders, 34 second wave fundholders, 9 third wave fundholders, and 268 non-fundholders. MAIN OUTCOME MEASURES: Prescribing costs per 1000 patients, prescription items per 1000 patients, average cost per item, and rate of generic prescribing. RESULTS: Prescribing costs and frequency increased in all groups throughout the study. Among the fundholders the rate of increase in costs after fundholding was significantly lower than among non-fundholders. The rate of increase in cost per item fell, coinciding with a significant increase in the rate of generic prescribing. However, with regard to first wave fundholders, their yearly increase in costs in their third year as fundholders (1995-6) was similar to that of the non-fundholders. The earlier practices that joined the scheme seemed to differ in some important respects from those that joined later. CONCLUSIONS: After fundholders joined the fundholding scheme their patterns of prescribing changed compared with those of non-fundholders: the rate of increase in costs fell and there was a significant rise in the rate of generic prescribing.

Drug Costs↗
PubMed1997

Strategies to improve the cost effectiveness of general practitioner prescribing. An international perspective.

Prescribing costs are rising in all developed countries. The positive reasons for this are improved screening for diseases, aging populations and better drugs. The negative reason is prescribers' failure to use drugs cost effectively, i.e. in a scientifically and economically rational manner. It is for the latter reason that health administrators and managers, faced with cutbacks of other essential health provisions such as elective surgery, have found it necessary to intervene to attempt modification of general practitioner prescribing. This article describes the range of interventions in 3 continents, from the extreme of an essential drugs list to financial incentives and/or penalties for the patient and/or physician, to independent academic, educational interventions. The impact of hospital-initiated prescribing on general practice is briefly considered, as is the need to educate patients not to expect a prescription except when absolutely necessary. Finally, the inadequacy of medical school training in pharmacology and therapeutics is described, together with the need for formal postgraduate education in these topics for all prescribers, both general practitioner and hospital specialist.

Cost-Benefit Analysis↗
PubMed1996

Formulary revision: eliciting the opinions of users.

BACKGROUND: Few peer-reviewed reports have been published that document the extent and type of use of published formularies in general practice. As publishers of the Practice Formulary of the Royal College of General Practitioners, the Northern Ireland Faculty Board commissioned a large-scale survey to quantify these issues, for the purpose of improving the revision process. AIM: The aim of the survey was to investigate the extent to which general practitioners in Northern Ireland use the Practice Formulary and the ways in which they use it, and to elicit their opinions on ways in which it could be improved. RESULTS: A total of 371 completed questionnaires were received (response rate of 38%), 49 respondents (13%) stating that they had not received the formulary. Out of the 322 respondents who had received it, 84% used the formulary occasionally, and 41% either had or were producing their own practice formulary (32% of these had used the RCGP formulary in its production). Almost all respondents (90%) considered a formulary useful in general practice. The presentation and layout was approved by 273 respondents (85%) and 259 (80%) agreed strongly with the drug selection. The formulary was used as a source of drugs information by 191 respondents (59%) and as a teaching aid by 103 (32%). A total of 65 criticisms or suggestions for improving the next edition were received. Revision is now under way and 18 of the original respondents have volunteered to be members of the revision committee. No judgement was made about the non-respondents. CONCLUSION: The largest survey yet conducted of published formulary use in one region elicited the extent of use, type of use, criticisms and suggestions for improvement. These suggestions are being used as a guide to revision of the next edition.

Attitude of Health Personnel↗
PubMed1994

A 'compass' for general practitioner prescribers.

This paper records the result of research and development in interrogating a general practitioner prescription pricing database to provide customised analysis for every practice. The system 'COMPASS' (Computerised On-line Monthly Prescribing Analysed for Science and Stewardship) is described, and identifies instances where each practice might improve cost-effectiveness and scientific rationality in prescribing. One hundred and two such instances are interrogated. This initial COMPASS report is then supplemented by screening the database to show a practice's: 1. range of drugs used--an excessive range should be discouraged. 2. use of drugs often used imprecisely--eg, antibiotics. 3. predicted prescribing cost--based on practice demography. 4. use of drugs with very limited GP value--eg, peripheral vasodilators. Northern Irish fundholding general practitioners are finding COMPASS valuable in planning improvement in cost-effectiveness and quality.

Cost Savings↗
PubMed1993

Market penetration of new drugs in one United Kingdom region: implications for general practitioners and administrators.

OBJECTIVE: To determine the use of new drugs in one United Kingdom region. DESIGN: Examination of data on prescribing of angiotensin converting enzyme inhibitors, new broad spectrum antibiotics, and H2 receptor antagonists. Calculation of number of defined daily doses prescribed each month. SETTING: All general practices in Northern Ireland. MAIN OUTCOME MEASURES: Drug use index and market share of each drug. RESULTS: During 1988-91 prescribing of angiotensin converting enzyme inhibitors increased by 126%, of H2 receptor antagonists by 46%, and of new antibiotics by 207%. The first drug on the market usually retained the largest market share. Use of oral antibiotics increased threefold irrespective of the reporting policy of the general practitioners' local laboratory. CONCLUSIONS: The increase in prescribing of these drugs seems to be greater than can be accounted for by an increase in patients with specific indications for these drugs. This suggests that the profession has not instituted effective checks to ensure that the legitimate promotion of new products does not lead to inappropriate and wasteful use.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1992

Relationship between the number of partners in a general practice and the number of different drugs prescribed by that practice.

The objective of this study was to assess whether practice size, as measured by the number of doctors, had any bearing on the range of drugs prescribed. All practices in the northern and western health boards in Northern Ireland were included in the study--a total of 132 practices (362 doctors) serving a population of 628,249. Prescribing data, obtained from the Department of Health and Social Services (Northern Ireland) information technology unit database, were analysed retrospectively for the month of January 1989. The number of different preparations prescribed in each of 22 therapeutic groups were counted. Hence a measure of the range of prescribing was assessed. A significant correlation was found between the number of different preparations prescribed and the number of general practitioners working in the practice. However, no correlation was found between the number of different drugs prescribed and the mean prescribing cost per patient or the mean list size of the doctors in each practice. The use of a practice prescribing policy was found to have no influence on the range of drugs prescribed, nor on the prescribing costs. The inference is that formal therapeutic policies may be difficult to implement within group practices. These results are of importance to general practitioners since the greater the number of different drugs prescribed the greater will be the risk of side effects and dangerous interactions.

Drug Costs↗
PubMed1988

Some patterns of prescribing by urban general practitioners.

To detect the differences in patterns of prescribing between general practitioners with high and low costs, the costs in prescribing seven symptomatic and seven systematic drug groups were studied in 23 practices with low costs and 23 with high costs in the Belfast area. This was done by extracting information about the individual practices from the Department of Health and Social Services (Northern Ireland) information technology unit's database on prescribing. General practitioners in practices with high costs issued prescriptions more often and for larger quantities of medicine than did their colleagues in practices with low costs for all of the drug groups studied. There was a lower patient to doctor ratio in the practices with high costs (1786:1 v 2039:1). The prescribers with high costs offered more surgery sessions than their colleagues with low costs, amounting to an average of 6.5 extra surgery sessions per 1000 patients per month. Half as many more patients with heart disease, asthma, diabetes, and thyroid disease seemed to be treated by doctors in practices with high costs than in practices with low costs. A higher rate of prescribing symptomatic drugs by these same doctors was also seen, and further study is recommended in view of the risks associated with these drugs.

Costs and Cost Analysis↗