Around 60,000 patients in Scotland are being prescribed drugs with a high risk of side-effects, according to new research from Dundee University.
The report concludes that high rates and large variation between practices is consistent with significant room for improvement.
Dr Guthrie said, “It’s all about improving the quality of prescribing. At the moment, GP practices do not get this kind of information.
“We feel it would be helpful to let practices know how they compare to others and think the number of vulnerable patients being prescribed high risk drugs can be reduced.”
NHS Quality Improvement Scotland and the Scottish Government Chief Scientist Office funded the study.
Dr Guthrie says the next stage is further research into guidelines to reduce the number of deaths and ill health caused by high-risk prescribing.
Photo used under a Creative Commons licence courtesy of Flickr user Charles Williams.
Professor Bruce Guthrie and colleagues in the medical school’s Centre for Primary Care and Population Research examined the frequency of high-risk prescribing in primary medical care and the patient and practice characteristics associated with it.
They studied prescribing records and other data from 315 Scottish general practices with 1.76 million registered patients and examined the proportion of patients receiving a high-risk prescription using a composite of 15 indicators.
These included using anti-psychotic drugs in dementia sufferers, prescription of non-steroidal anti-inflammatory drugs like ibuprofen to people with previous stomach ulcer or kidney problems and prescription of drugs recommended to be avoided in people with heart failure.
The team found that high-risk prescribing is common, with 139,404 (7.9%) registered patients defined as being “at risk” of receiving selected high-risk drug due to their age, pre-existing disease or co-prescription.
Almost 20,000 of those had been prescribed at least one high-risk drug in the previous year.
This study shows that high-risk prescribing associated with harm can be reliably measured using routine clinical data, that it is relatively common and that rates of such prescribing vary greatly in different general practices.
Professor Guthrie says it is important to recognise that high-risk prescriptions can be appropriate because clinicians and patients try to balance benefit and risk in complex situations where there is no “correct” action.
However, the big differences between practices indicate that prescribing could be made safer.
Dr Guthrie said, “The implications are that our study looked at a sample of about a third of Scottish patients.
“If you take this across the whole of Scotland, then approximately 60,000 people particularly vulnerable to side-effects might be being prescribed high-risk drugs.
“This may be the correct course of action and bring benefits to the patient but it has to be balanced against the dangers.”Particular risk”We’re not saying that all this type of prescribing should not be happening, but that we have to be satisfied that it’s appropriate and ensure that doing so doesn’t put the patient at more risk.
“All prescribing is risky to some extent, but the drugs we examined are particularly risky in some patients and we have to balance the benefits derived from these drugs and with the risks of taking them.
“We can’t make sweeping statements about people routinely being put at risk because of inappropriate prescribing.
“We would need to know more about the individual circumstances of the patient, but the fact high-risk prescribing varies between practices suggests that there is scope to make prescribing safer.”
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