Abstract
Objective The objective of this research was to examine differences in patterns of statin prescribing between Northern Ireland and England both before and after the introduction of the Quality and Outcomes Framework (QOF). Setting: Primary care practices in Northern Ireland and England. Method Northern Ireland practices were matched with practices in England, statin prescribing data and QOF achievement scores (for the first year post-QOF) were obtained. Crude prescribing data from matched practices were manipulated to provide a data set of Defined Daily Doses (DDDs)/1,000 patients and cost/DDD/1,000 patients for each statin drug entity covering 1 year before and after the introduction of QOF. QOF achievements were converted into percentage scores for matched practices. Main outcome measure Cost per defined daily dose (DDD) per 1,000 patients. Results Significantly less statins (DDD/1,000 patients) were dispensed in Northern Ireland compared with the matched region in England both before and after the introduction of QOF (P < 0.001). However, significantly more statins were dispensed in both regions after the introduction of QOF. As a result of the introduction of QOF, the cost/DDD/1,000 patients rose by £13.17 in NI, but fell by £3.76 in the matched region in England. Conclusion Strategies should be considered to educate prescribers on cost-effectiveness by increasing their awareness of the negative budgetary impact resulting from early adoption of new and expensive statins and by encouraging generic prescribing.
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References
Bradley CP. Decision-making and prescribing patterns—a literature review. Fam Pract. 1991;8(3):276–87.
Fretheim A, Oxman AD. International variation in prescribing antihypertensive drugs: its extent and possible explanations. BMC Health Serv Res. 2005;5:21–31.
Jacoby A, Smith M, Eccles M. A qualitative study to explore influences on general practitioners’ decisions to prescribe new drugs. BJGP. 2003;53(487):120–5.
Morgan SG, Bassett KL, Wright JM, Evans RG, Barer ML, Caetano PA, et al. “Breakthrough” drugs and growth in expenditure on prescription drugs in Canada. BMJ. 2005;331:815–6.
Moon JC, Bogle RG. Switching statins—using generic simvastatin as first line could save 2bn pound over five years in England. BMJ. 2006;332:1344–5.
Campbell SM, Roland MO, Middleton E, Reeves D. Improvements in quality of clinical care in English general practice 1998–2003: longitudinal observational study. BMJ. 2005;331:1121–3.
Campbell S, Reeves D, Kontopantelis E, Sibbald B, Roland M. Effects of pay for performance on the quality of primary care in England. N Engl J Med. 2009;361(4):368–78.
National Health Services. Quality and outcomes framework information. 2006. Government document available from http://www.gpcontract.co.uk/FAQ.php.
Maisey S, Steel N, Marsh R, Gillam S, Fleetcroft R, Howe A. Effects of payment for performance in primary care: qualitative interview study. J Health Serv Res Pol. 2008;13(3):133–9.
Kenny C. Diabetes and the quality and outcomes framework—successful UK initiative highlights inequity of investments between sectors. BMJ. 2005;331:1097–8.
Doran T, Drever F, Whitehead M. Health underachievement and overachievement in English local authorities. J Epidemiol Commun Health. 2006;60(8):686–93.
Hadley-Brown M. The QOF: quality outcomes or just framework? Diabetes Prim Care. 2005;7:52–60.
Appleby J. Independent review of health and social care services in Northern Ireland. 2005. http://www.dhsspsni.gov.uk/appleby-section3-4.pdf.
Scoggins A, Tiessen J, Pabinovich L. Prescribing in primary care: understanding what shapes GP’s prescribing choices and how might these be changed. Technical report prepared for the National Audit Office. Cambridge, UK: RAND Corporation; 2006.
Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease. The Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383–9.
Cook J, Yin D, Alemao E, Drummond M. Development and validation of a model to project the long-term benefit and cost of alternative lipid-lowering strategies in patients with hypercholesterolaemia. Pharmacoeconomics. 2004;22(S3):37–48.
Petty D, Lloyd D. Can cheap generic statins achieve national cholesterol lowering targets? J Health Serv Res Pol. 2008;13(2):99–102.
Peck P. Statins are underused and under dosed, even in clinical trial population: Medscape. 2004. http://www.medscape.com/viewarticle/471276.
Gumbs P, Verschuren W, Souverein P, Mantel-Teeuwisse A, de Wit G, de Boer A, et al. Society already achieves economic benefits from generic substitution but fails to do the same for therapeutic substitution. Br J Clin Pharmacol. 2007;64(5):680–5.
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The authors would like to thank Dr Gordon Cran, Department of Epidemiology, Queen’s University Belfast for his statistical support.
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Alabbadi, I., Crealey, G., Turner, K. et al. Statin prescribing in Northern Ireland and England pre and post introduction of the quality and outcomes framework. Pharm World Sci 32, 43–51 (2010). https://doi.org/10.1007/s11096-009-9339-3
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DOI: https://doi.org/10.1007/s11096-009-9339-3