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Explanations for variations in clopidogrel prescribing in England.
1Medicines Management and Pharmacy Practice Group, School of Healthcare, University of Leeds, Leeds, UK. d.petty@leeds.ac.uk
Journal of Public Health (Oxford, England)
|July 2, 2008
Summary
The National Audit Office indicator for clopidogrel prescribing may misidentify performance. Factors like cardiovascular disease prevalence and deprivation significantly impact prescribing, requiring consideration before action.
Area of Science:
- Health Services Research
- Pharmacoeconomics
- Clinical Pharmacy
Background:
- National Audit Office (NAO) developed prescribing indicators for Primary Care Trusts (PCTs).
- Clopidogrel, an antiplatelet, is an indicator due to its higher cost compared to aspirin, suggesting potential cost savings.
- The study evaluates the validity of the NAO's clopidogrel prescribing indicator.
Purpose of the Study:
- To assess the validity of the NAO's clopidogrel prescribing indicator.
- To determine if the defined daily dose (DDD) per Specific Therapeutic Age Related Prescribing Unit (STAR-PU) accurately reflects prescribing performance.
Main Methods:
- Acquired prescribing data for 152 PCTs and relevant explanatory variables.
- Conducted correlation analysis to understand variable relationships.
- Performed regression analysis to compare prescribing (dependent variable) with identified explanatory factors.
Main Results:
- Coronary heart disease prevalence and Index of Multiple Deprivation explained 30% of prescribing variation (DDD/STAR-PU) between PCTs.
- Despite age and sex adjustments, other patient need indicators influenced prescribing patterns.
Conclusions:
- The DDD/STAR-PU indicator alone may inaccurately classify PCTs regarding clopidogrel use.
- PCT performance rankings should be thoroughly investigated considering cardiovascular morbidity and deprivation before implementing corrective measures.
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