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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR11

The development of a locality profile for use in primary care health needs assessment

By A. Muir, S. Hudson, S. Bryson*, J. W. E. Forrester* and S. McKellar

Introduction The formation of primary care groups (PCGs) and local health care co-operatives (LHCCs in Scotland) provides an opportunity for a pharmaceutical contribution to the planning of health care initiatives to meet local health care needs. Local health care needs assessment requires the use of a range of methodologies.1,2 Local disease prevalences presently cannot be readily quantified3 and prescribing data can be used selectively as a proxy for estimating specific disease prevalences.4 Prescribing data are routinely captured and prescribing indices are advocated to help monitor prescribing at individual practice level.5 However, the use of a prescribing database as a public health tool appears to be relatively unexplored.
This study examines the potential value of aggregating current prescribing data at PCG/LHCC level.

Method Public health and prescribing databases were examined to characterise two chosen general medical practice populations (A and B) with contrasting low and high social deprivation (A=36 876 and B=15 530; Carstairs category 1 and Carstairs categories 5-7, respectively). The contrasting census characteristics exemplifying the populations from which A and B, respectively, were drawn include: male, unemployment, 6 and 32 per cent; female, unemployment, 4 and 19 per cent; males in social class IV and V, 5 and 38 per cent; single parent families, 6 and 30 per cent; proportion permanently sick, 3 and 18 per cent.
An expert panel consisting of three public health pharmacists, a public health physician, a general medical practitioner, a community pharmacist, a medical prescribing adviser and a pharmacy prescribing advisor met six times to reduce the database into a manageable tool which could then be examined statistically.

Focal points

  • Prescribing data have a potential for informing local health care needs assessment
  • A basket of prescribed items and prescribing indicators has been generated to potentially reflect differences in socio-economic characteristics
  • Prescribing data may help to fill gaps in understanding of local disease prevalences
  • Prescribing data reflect patient encounters with the pharmaceutical services and may help in the planning of local pharmacy service initiatives

Results Analysis of the initial prescribing database showed that the profile of prescribing across the British National Formulary chapter categories for locality B ranged from 110 to 306 per cent of that in locality A, except for drugs used in "malignant disease and immunosuppression".
The consensus panel compressed 128 prescribing data items and 194 public health data items into a population profile of 48 and 41 items, respectively. Individual prescribed items that did not help to discriminate the use of medicines in these highly contrasting populations were eliminated as unlikely to be more generally useful. A basket of 36 prescribed items chosen to reflect variations in local health care needs was finally generated by further exclusion of items with a prescribing frequency not statistically different in the two populations and not differing by more than 20 per cent. From that basket of prescribed items, 12 prescribing indices have been proposed (Table 1) for further investigation of their utility.

Table 1

Discussion Prescribing data offer an additional source of information that is routinely and reliably captured and which might add to the comprehensiveness of the process of local health care needs assessment. The interpretation of prescribing data is generally confounded by variables in the prescribing process unrelated to health care needs. However, the aggregation of data from groups of practices to reflect prescribing to larger populations would be expected to reduce the effect of confounding variables and favour the use of the data to reveal underlying characteristics that might inform the matching of pharmaceutical care to the needs of the populations.
Prescribing data reflect patient encounters with the pharmaceutical services and, as such, the opportunities for pharmacists' contributions to health care initiatives.
Prescribing data requires to be manipulated into manageable tools that can be evaluated for use within PCGs and LHCCs.

Department of pharmaceutical sciences, University of Strathclyde; *Greater Glasgow health board, Glasgow

References

1. Wilkieson JR, Murray SA. Assessment in primary care: practical issues and possible approaches. BMJ 1998;316:1524-8.
2. Murray SA, Graham LJC. Practice based health needs assessment: use of four methods in a small neighbourhood. BMJ 1995;310:1443-8.
3. Charlton BG, Calvert N, White M, Rye GP, Conrad W, van Zwanenberg T. Health promotion priorities for general practice: constructing and using "indicative prevalences". BMJ 1994;308:1019-22.
4. Clarke KW, Gray D, Hampton JR. Implications of prescriptions for nitrates: 7 year follow up of patients treated for angina in general practice. Br Heart J 1994;71:38-40.
5. Accounts Commission for Scotland. Supporting prescribing in general practice. London: Stationery Office; 1999.