Substantial variation exists between GPs in uptake of new prescribing guidance, with important implications for patient care and health expenditure, finds the largest analysis of its kind published by the BMJ today.
Using data for more than 8000 GPs in England over a five-year period, the study examined the timing of the largest changes, steepness of the change slope and magnitude of the change for two examples: expiry of the Cerazette patent in 2012, leading to cheaper generic desogestrel alternatives becoming available and change in antibiotic prescribing after the 2014 guidelines which favoured nitrofurantoin over trimethoprim for uncomplicated urinary tract infection (UTI).
The findings show that most practices changed their prescribing behaviour, but some changed much later than others, leading to avoidable health service costs and poorer patient care.
For desogestrel, the range of time delay before a change was implemented was between two and 14 months, with a median of eight months. For UTIs, the time delay ranged from five to 29 months, with a median of 18 months.
Substantial heterogeneity was also seen in reduced prescribing of Cerazette and trimethoprim following a detected change, with the absolute reduction per month ranging from 2-28 per cent per month (median, 9%) and 1-8 per cent (median, 2%), respectively.
The authors remark that this heterogeneity in implementing warranted changes “exposes health systems to substantial avoidable costs and exposes patients to suboptimal clinical care.”
“Although expecting all practices to respond immediately and adopt optimal prescription behaviour might be unrealistic, the fact that some practices changed both early and rapidly suggests that rapid timely change is possible,” they say.