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Variation in duration of repeat prescriptions: a primary care cohort study in England
Brian MacKenna1, Andrew D Brown2, Richard Croker2
1Nuffield Department of Primary Care Health Sciences (NDPCHS), University of Oxford, Oxford, UK; Bennett Institute for Applied Data Science, NDPCHS, University of Oxford, Oxford, UK brian.mackenna@phc.ox.ac.uk.
Background:
Many patients receive repeat prescriptions for routine medications used to treat chronic conditions. Doctors typically issue repeat prescriptions with durations ranging from 28 to 84 days. There is currently no national guidance in England for the optimal prescription duration for routine medications.
Aim:
To evaluate current prescription durations for five common routine medications in England; explore and visualise geographical variation; and identify practice factors that are associated with shorter prescribing duration to inform policy making.
Design And Setting:
A retrospective cohort study of NHS primary care prescribing data in England from December 2018 to November 2019.
Method:
The prescription duration was analysed for five common routine medications in England; ramipril, atorvastatin, simvastatin, levothyroxine, and amlodipine. Variation was assessed between regional clinical commissioning groups (CCGs), and practice factors associated with different durations were identified.
Results:
Of the common medications included, 28-day prescriptions accounted for 48.5% (2.5 billion) tablets/capsules issued, while 43.6% were issued for 56 days. There was very wide regional variation (7.2%-95.0%) in the proportion of 28-day prescriptions issued by CCGs. Practice dispensing status was the most likely predictor of prescription duration; dispensing practices had a higher 28-day prescribing proportion than non-dispensing practices. The proportion of patients with chronic conditions and the electronic health record system used by a practice were also associated with prescription duration.
Conclusion:
This analysis of OpenPrescribing data showed that repeat prescriptions of 28 days are common for patients taking routine medications for chronic conditions, particularly in dispensing practices. This provides data to inform the policy debate on current practice. Configuration of electronic health record systems offer an opportunity to implement and evaluate new policies on repeat prescription duration in England.
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