Understanding the Appropriateness of Prescribing in Primary Care

Objectives: To understand the appropriateness of prescribing in primary care using hypertension as a model.Methods: Case notes review in a single general practice. All patients in the practice currently receiving drug treatment for hypertension.Results: Five hundred and forty-four patients were currently on drug treatment for hypertension. Sixty-two percent of patients were taking one antihypertensive preparation, 32% were taking two, 7% were taking three or more; 22% were taking a combination product. Forty percent of patients had comorbidities which could influence drug choice or were complications of hypertension. With respect to previous treatment, 29% had used no prior preparations, 25% had used one, 18% had used two, 10% had used three, and 19% had used four or more. The commonest reason for changing treatment was drug side effects (39%) followed by failure to control blood pressure (34%).Conclusions: It has been possible to examine the appropriateness of prescribing for a specified clinical condition within one general practice. This was a complex process, requiring a detailed knowledge of patients’ past and current clinical and drug histories. Such understanding cannot be gained from PACT data. Where therapies have multiple indications and where treatment decisions are complex such a method is necessary to fully understand the appropriateness of prescribing.