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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 pR52

Characteristics of general practices with different asthma prescribing

By J. Salamzadeh, M. G. Patel, I. C. K. Wong, D. J. Wright and H. Chrystyn

Introduction Previous studies have shown that there might be a relationship between practice/demographic characteristics and drugs prescribed for or used by asthmatics.1-3 The current study was designed to investigate the possible differences between practices with high and low quality of asthma prescribing in the Bradford health authority (BHA). The characteristics compared in this study are Jarman score (JS); Townsend index (TI); percentage of South Asians registered within each practice (PSA); number of patients per GP (PPGP); fund-holding (FH) and non-fund-holding (NFH) status; and the number of practitioners in the practices, single-handed (SH) or multi-practitioner (MP).

Method PACT data of 62/97 consenting practices, including 199/271 GPs, were obtained and the number of defined daily doses (DDDs) for preventers and bronchodilators were calculated. According to the BTS guidelines the ratio of preventers to bronchodilators (P:B) is an indicator for the quality of prescribing for asthmatic patients.3 Practices were divided into two groups, high and low quality of asthma prescribing, based on the median (0.495) of the P:B ratios. Chi-square and the Mann-Whitney tests were used to compare the differences between practices with high and low P:B ratios.

Focal points

  • An indicator of quality for prescribing in asthma using the preventive to bronchodilator ratio was calculated from defined daily doses obtained from PACT data
  • Sixty-four per cent of the practices in the health authority consented to this analysis of their data
  • Practices with a lower ratio of preventers to bronchodilators have on average a greater workload and are in higher deprivation rate areas with a larger percentage of registered South Asian patients
  • These practices could benefit from joint initiatives for the disease management of asthma

Results From 62 practices, 16 were SH (10 in the low and six in the high quality group) and 46 were MP (21 in the low and 25 in the high quality group). Also there were 11 and 17 FH practices, and 20 and 14 NFH practices in the low and high quality groups, respectively. The FH and NFH status, and being SH and MP for practices with high and low P:B ratios were not significantly different. A summary of the statistical analysis of the remaining variables is shown in Table 1.

Table 1

Conclusion Using the P:B ratio as an indicator of asthma prescribing suggests that practices with lower prescribing quality have significantly higher workload and PSA. Also practices with low prescribing quality are located in the areas with a higher deprivation rate. Other studies have shown that deprivation might be more associated with lower compliance/self management, fewer educational attainments and poorer environmental conditions leading to an inappropriate usage of the medication.3,4 Duran-Tauleria et al reported that the risk of undertreatment of asthma is higher in children from the ethnic minority groups.5 Joint initiatives for disease management of asthma should initially focus on practices with the low ratios of P:B. It should be contemplated that the PACT data used in this study also includes drugs prescribed for COPD and bronchitis. To achieve more accurate results, the use of individual prescribing information of asthmatics and outcomes of the treatment is in progress.

Pharmacy practice research unit, school of pharmacy, University of Bradford, Bradford BD7 1DP

References

1. Sturdy P, Naish J, Pereira F, Griffiths C, Dolan S, Toon P, Chambers M. Characteristics of general practices that prescribe appropriately for asthma. BMJ 1995;311:1547-8.
2. Griffiths C, Sturdy P, Naish J, Omar R, Dolan S, Feder G. Hospital admissions for asthma in East London: association with characteristics of local general practices, prescribing, and population. BMJ 1997;314:482-6.
3. Shelly M, Croft P, Chapman S, Pantin C. Is the ratio of inhaled corticosteroid to bronchodilator a good indicator of the quality of asthma prescribing? Cross-sectional study linking prescribing data to data on admission. BMJ 1996;313:1124-6.
4. Littlejohns P, MacDonald LD. The relationship between severe asthma and social class. Res Med 1993;87:139-143.
5. Duran-Tauleria E, Rona R J, Chinn S, Burney P. Influence of ethnic group on asthma treatment in children in 1990-1: national cross sectional study. BMJ 1996;313:148-152.