GP surgeries across Tayside may be too busy and too understaffed to address the increasing risk to patients caused by dangerous prescribing by doctors, a study suggests.
Researchers at Dundee University and NHS Tayside undertook a significant study into “high-risk” prescribing, which is now responsible for 4% of emergency hospital admissions.
They concluded that preventable drug-related complications are now “common” and “causing harm” to patients. Their study encompassed 33 GP practices across the region and more than 200,000 registered patients.
The study also revealed possible solutions to the problems, highlighting that a change in prescribing patterns could lead to significant reductions in related emergency hospital admissions.
It also recommends intervention in primary health care practices and regular reviews to assess the appropriateness of prescribing.
Researchers called on the NHS and other agencies to act on the findings, but fear that may not be possible.
Professor Bob Guthrie from Dundee University admitted that persuading practices to allocate staff resources to improving the safety of prescribing was “challenging”.
He said: “Our previous work has shown that high-risk prescribing is common and often causes important harm.”
The majority of drug-related emergency admissions are caused by commonly prescribed drugs, with substantial contributions from non-steroidal anti-inflammatory drugs and anti-platelet medications like aspirin because of gastrointestinal, cardio-vascular, and renal adverse drug events.
Despite routine public reporting of a number of indicators of high-risk prescribing, variation between practices and different areas is said to be large and improvement over time fairly minimal.
The report stresses that decisions about prescribing often involve balancing benefits and risks as well as the preferences of the patient, and high-risk prescribing is therefore sometimes appropriate, since benefits may be judged to outweigh the risk of harm in an individual.
Nevertheless, say the researchers, high-risk prescribing is so common and varies so much between general practices that they would expect it to be improvable and, at a minimum, regular review is required to assess continuing appropriateness in patients receiving such prescribing.
The study’s results were published in the New England Journal of Medicine.
A further study is already under way to evaluate the impact of expanding the range of high-risk prescribing to be targeted, with more work planned to involve local pharmacists in the review process.