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Low-value pharmaceutical care among Dutch GPs: a retrospective cohort study
Joris Ljm Müskens1, Simone A van Dulmen1, Tjerk Wiersma2
1Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Centre, Nijmegen.
Background:
Low-value pharmaceutical care exists in general practice. However, the extent among Dutch GPs remains unknown.
Aim:
To assess the prevalence of low-value pharmaceutical care among Dutch GPs.
Design And Setting:
Retrospective cohort study using data from patient records.
Method:
The prevalence of three types of pharmaceutical care prescribed by GPs between 2016 and 2019 were examined: topical antibiotics for conjunctivitis, benzodiazepines for non-specific lower back pain, and chronic acid-reducing medication (ARM) prescriptions. Multilevel logistic regression analysis was performed to assess prescribing variation and the influence of patient characteristics on receiving a low-value prescription.
Results:
Large variation in prevalence as well as practice variation was observed among the types of low-value pharmaceutical GP care examined. Between 53% and 61% of patients received an inappropriate antibiotics prescription for conjunctivitis, around 3% of patients with lower back pain received an inappropriate benzodiazepine prescription, and 88% received an inappropriate chronic ARM prescription during the years examined. The odds of receiving an inappropriate antibiotic or benzodiazepine prescription increased with age (P<0.001), but decreased for chronic inappropriate ARM prescriptions (P<0.001). Sex affected only the odds of receiving a non-indicated chronic ARM, with males being at higher risk (P<0.001). The odds of receiving an inappropriate ARM increased with increasing neighbourhood socioeconomic status (P<0.05). Increasing practice size decreased the odds of inappropriate antibiotic and benzodiazepine prescriptions (P<0.001).
Conclusion:
The results show that the prevalence of low-value pharmaceutical GP care varies among these three clinical problems. Significant variation in inappropriate prescribing exists between different types of pharmaceutical care - and GP practices.
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