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Biomedical subjects

H McGavock

Publications and source records attributed to H McGavock.

At least 19 recordsLinked to original sources
PubMed1999

Antibiotic prescribing for respiratory tract infections in general practice.

OBJECTIVES: (1) To describe interpractice variation in diagnosis of respiratory infections at consultation. (2) To test the hypotheses that: (a) The decision to prescribe an antibiotic in respiratory infection is influenced by the diagnosis, the perceived certainty of diagnosis, and whether or not a consultation takes place. (b) The choice of antibiotic is influenced by the diagnosis. DESIGN: A regional survey of prescribing and associated morbidity in general practice, over a 2-week period in April 1994. SETTING: Stratified quota sample of 22 Northern Ireland practices. RESULTS: There was wide interpractice variation in diagnosis of common respiratory infections at consultation, especially tonsillitis (5.0-157.5/1000 consultations). Overall, different diagnoses predicted the decision to prescribe an antibiotic at different levels (coryza 42.3%, tonsillitis 84.8%), but there was wide interpractice variation in the decision to prescribe for most diagnoses. With the exception of coryza and sinusitis, the perceived certainty of diagnosis did not significantly influence the decision to prescribe. The decision to prescribe was not significantly influenced by whether or not a consultation took place. Overall, broad spectrum penicillins were the therapeutic group most frequently prescribed for a given diagnosis with the exception of tonsillitis (phenoxymethylpenicillin) and sinusitis (tetracyclines), but there was wide interpractice variation in choice of antibiotic. CONCLUSIONS: Little consensus exists among practices regarding rational prescribing decisions in respiratory illness. The absence of a consultation was no deterrent to antibiotic prescribing. At one extreme, it is suggested that some practices are avoiding consultations for respiratory infections. There is wide variation in choice of antibiotic, despite existing guidelines.

Journal Article↗
PubMed1999

Repeat prescribing management--a cause for concern?

BACKGROUND: No existing studies of repeat prescribing management have been carried out on statistically adequate samples permitting an extrapolation of results with regard to the population of general practitioners (GPs). AIM: To provide adequate regional evidence of the quality of repeat prescribing management for the profession and its administrators, and to test a scoring system for quality assurance in repeat prescribing practice. METHOD: A semi-structured questionnaire was administered by one observer to a statistically representative population sample of Northern Ireland's general practices to investigate the extent to which they adopted recommended procedures for the management of repeat prescribing. Responses to 26 of these questions were used to score the quality of management. The subjects were a random sample of 57 practices stratified for number of partners, geographical area, and fundholding status. RESULTS: The main outcome measures were the percentage adoption of recommended procedures at the time of repeat prescription issue and at the review consultation, use of computing for repeat prescribing and the effects of fundholding; and quality assurance scores. During issue of repeats, essential checks are often omitted; the potential of computerization for improving management is often not realized. At review consultation, the opportunities for quality assurance are often missed. Fundholders manage repeat prescribing significantly better than non-fundholders, but in neither group is the mean management score exemplary. CONCLUSION: We have identified and quantified serious deficiencies in repeat prescribing management in a representative sample large enough to permit extrapolation to the regional population of GPs. In response, we have devised guidelines that GPs might use to address this problem. We have tested and proved a scoring system for repeat prescribing evaluation.

Drug Prescriptions↗
PubMed1998

Peripheral vasodilators and the management of peripheral vascular disease and Raynaud's syndrome in general practice.

There is no convincing evidence that peripheral vasodilators produce any significant improvement in exercise tolerance in patients with peripheral vascular disease, and these drugs may do more harm than good. In the treatment of severe Raynaud's syndrome, however, thymoxamine, prazosin or nifedipine is recommended. A descriptive study was carried out, firstly, to determine why these drugs are prescribed in general practice, and secondly, to describe the drug choices in the treatment of both Raynaud's syndrome and peripheral vascular disease in a representative sample of 22 practices in Northern Ireland. Of those patients prescribed peripheral vasodilators 69.6% were diagnosed as peripheral vascular disease, claudication or atherosclerosis. Over three-quarters of peripheral vasodilators prescribed were repeat prescriptions. Of those with Raynaud's syndrome only half were treated appropriately, and certainty of diagnosis did not guarantee appropriate treatment. Peripheral vasodilators accounted for the majority (51.5%) of items prescribed for peripheral vascular disease. A minority of patients with peripheral vascular disease (20.3%) were prescribed aspirin, and a smaller minority (4.4%) had undergone amputation. Peripheral vasodilators were prescribed unnecessarily and inappropriately. Measures to promote evidence-based treatment of both Raynaud's syndrome and peripheral vascular disease in general practice need to be taken.

Journal Article↗
PubMed1998

The use of angiotensin converting enzyme inhibitors in general practice--appropriate or inappropriate?

AIMS: To evaluate the pattern of prescribing of angiotensin-converting enzyme (ACE) inhibitors in general practice, related to the primary clinical diagnosis and concomitant medication. DESIGN: A descriptive survey of general practitioners' prescribing habits, presumptive diagnosis and patient demography over a period of 2 weeks in April 1994. SETTING: A stratified quota sample of 22 practices in Northern Ireland. RESULTS: The major clinical indication for the use of ACE inhibitors was essential hypertension (61.5%) with only a minority usage (19.9%) in congestive heart failure. Co-prescription of drugs with potential for interaction with angiotensin-converting enzyme inhibitors was not uncommon (16.7%). Of the 353 patients with a diagnosis of congestive heart failure, only 64 (18.1%) were receiving ACE inhibitors. The dosages used were lower than recommended for this indication. A significantly higher proportion of elderly patients with heart failure were prescribed hypnotic drugs (14.7% versus 8.3%; p<0.001) and had the co-existence of insomnia (11.8% versus 6.9%; p<0.001) compared to patients without heart failure. CONCLUSIONS: ACE inhibitors were underused in the treatment of congestive heart failure, and were often prescribed in suboptimal dosages. The frequent concurrent prescription of hypnotics and the co-existence of insomnia in heart failure may reflect this therapeutic strategy.

Journal Article↗
PubMed1997

How has fundholding in Northern Ireland affected prescribing patterns? A longitudinal study.

OBJECTIVE: To compare prescribing patterns in general practices before and after the introduction of fundholding in April 1993 to determine whether fundholding changed prescribing patterns among practices that joined the scheme. DESIGN: Analysis of prescribing data from the Drug Utilisation Research Unit's database for all practices in Northern Ireland during April 1989 to March 1996. SETTING: Northern Ireland. SUBJECTS: 23-first wave fundholders, 34 second wave fundholders, 9 third wave fundholders, and 268 non-fundholders. MAIN OUTCOME MEASURES: Prescribing costs per 1000 patients, prescription items per 1000 patients, average cost per item, and rate of generic prescribing. RESULTS: Prescribing costs and frequency increased in all groups throughout the study. Among the fundholders the rate of increase in costs after fundholding was significantly lower than among non-fundholders. The rate of increase in cost per item fell, coinciding with a significant increase in the rate of generic prescribing. However, with regard to first wave fundholders, their yearly increase in costs in their third year as fundholders (1995-6) was similar to that of the non-fundholders. The earlier practices that joined the scheme seemed to differ in some important respects from those that joined later. CONCLUSIONS: After fundholders joined the fundholding scheme their patterns of prescribing changed compared with those of non-fundholders: the rate of increase in costs fell and there was a significant rise in the rate of generic prescribing.

Drug Costs↗
PubMed1997

Temporal trends in drug use in one UK region, revealed by chemical group matching.

(1) The pharmaceutical pricing data for Northern Ireland were amended to include defined daily dosages (DDD) for all single chemical entities. Eight therapeutic groups were studied: antiasthmatics, antidepressants, antimicrobials, benzodiazepines, hormone replacement therapy (HRT), hypoglycaemics, lipid-lowering agents and ulcer-healing drugs. Each group was then subdivided into its main chemical groups. The regional use of each chemical group was defined as the combined DDDs of its individual chemical entities per quarter year, from January 1989 until December 1994. (2) During this period, drug use increased in all eight therapeutic groups and in most of their constituent chemical groups. Increased use of newer drugs did not cause the expected decrease in use of established drugs. Use of all broad-spectrum antimicrobials increased by 314%. Use of sedative benzodiazepines decreased slowly and steadily (16%) throughout the study period but use of all hypnotics increased inexplicably by 21% in 1992 reaching a plateau in 1993 and 1994. SSRI antidepressant use increased sharply (5333%) following their introduction in 1989, accompanied by a 24% increase in use of tricyclic antidepressants. There was a 23,626% increase in the use of proton pump inhibitors and a smaller but steady increase of 38% in use of histamine H(2) antagonists; it is unlikely that much of the prescribing of anti-ulcer and antimicrobials was accurately targeted and rationally defensible. (3) More positively, use of beta(2)-agonist inhalers increased by 45% despite a 254% increase in the use of inhaled steroids. Use of HRT increased by 389% though evidence of under-use is given. There was a steady increase in the use of both insulins (28%) and oral hypoglycaemics (34%). The use of 'statins' (690%) and fibrates (123%) increased. (4) The possible interpretations and implications of these patterns of drug use is discussed, together with their potential as proxies for morbidity incidence in the community.

Journal Article↗
PubMed1997

Predicting prescribing costs in general practice using practice demography.

Prescription and dispensing costs form a large part (c. 56%) of primary care expenditure in the NHS and concern has been expressed at its ever increasing total. Previous predictive models have either failed to account for a high proportion of costs or else have not been able to explain adequately the role practice list demography plays upon costs. Using prescription data and the practice demography, our model accounts for 91.4% of the variation in primary health care prescribing costs in Northern Ireland thus explaining them to a much greater extent than previous models and, in addition, explains a large part of the variation in total monthly consultations and numbers of prescriptions. In addition to comprehensiveness it has a high degree of parsimony, needing only three independent variables for each practice, namely, the number of children aged 0-4 years, the number of persons aged 60+ years and the number of partners in the practice, all of which are immediately comprehensible by GPs and their negotiators. Thus, it could form a valuable addition to the 'evaluation kit' of prescribing advisers and others concerned with auditing and containing costs. Previous studies have shown the importance of the age-sex structure of practice lists in relation to prescribing costs but none has been able to develop such a powerful, simple and comprehensible predictive model.

Journal Article↗
PubMed1997

Research methodology: Coding perceived morbidity in general practice--an evaluation of the Read Classification and the International Classification of Primary Care (ICPC).

OBJECTIVES: To evaluate the Read Classification and the International Classification of Primary Care (ICPC). METHODS: The Read Classification was used to code the diagnoses for 3474 patient encounters, in a pilot sample of three volunteer practices (11 general practitioners), and the ICPC was used to code 21,416 patient encounters in a stratified quota sample of 22 practices (59 general practitioners), in a survey aiming to relate prescribing to perceived diagnosis. RESULTS/EXPERIENCE: The Read Classification was found to be a detailed and exhaustive classification of medical diagnoses, but it was more time consuming to use than the ICPC, due to the complexity of the classification, the over-use of alpha characters compared to the ICPC, and the mixing of alpha characters with numeric digits within the codes. Encoding, decoding and statistical analysis were found to be more straightforward using the ICPC compared with the Read Classification. The ICPC was found to be deficient in 40 important diagnoses, and these are listed. CONCLUSION: The Read Classification was of limited value in this drug utilization survey, in that the design of the code reduced its utility in statistical analyses. The ICPC was an efficient code, which met the criteria of exclusiveness, usefulness and hierarchy. The classification is not exhaustive enough to prevent loss of information as a result of coding, but the authors' amendments virtually eliminated this problem.

Journal Article↗
PubMed1997

Strategies to improve the cost effectiveness of general practitioner prescribing. An international perspective.

Prescribing costs are rising in all developed countries. The positive reasons for this are improved screening for diseases, aging populations and better drugs. The negative reason is prescribers' failure to use drugs cost effectively, i.e. in a scientifically and economically rational manner. It is for the latter reason that health administrators and managers, faced with cutbacks of other essential health provisions such as elective surgery, have found it necessary to intervene to attempt modification of general practitioner prescribing. This article describes the range of interventions in 3 continents, from the extreme of an essential drugs list to financial incentives and/or penalties for the patient and/or physician, to independent academic, educational interventions. The impact of hospital-initiated prescribing on general practice is briefly considered, as is the need to educate patients not to expect a prescription except when absolutely necessary. Finally, the inadequacy of medical school training in pharmacology and therapeutics is described, together with the need for formal postgraduate education in these topics for all prescribers, both general practitioner and hospital specialist.

Cost-Benefit Analysis↗
PubMed1996

Formulary revision: eliciting the opinions of users.

BACKGROUND: Few peer-reviewed reports have been published that document the extent and type of use of published formularies in general practice. As publishers of the Practice Formulary of the Royal College of General Practitioners, the Northern Ireland Faculty Board commissioned a large-scale survey to quantify these issues, for the purpose of improving the revision process. AIM: The aim of the survey was to investigate the extent to which general practitioners in Northern Ireland use the Practice Formulary and the ways in which they use it, and to elicit their opinions on ways in which it could be improved. RESULTS: A total of 371 completed questionnaires were received (response rate of 38%), 49 respondents (13%) stating that they had not received the formulary. Out of the 322 respondents who had received it, 84% used the formulary occasionally, and 41% either had or were producing their own practice formulary (32% of these had used the RCGP formulary in its production). Almost all respondents (90%) considered a formulary useful in general practice. The presentation and layout was approved by 273 respondents (85%) and 259 (80%) agreed strongly with the drug selection. The formulary was used as a source of drugs information by 191 respondents (59%) and as a teaching aid by 103 (32%). A total of 65 criticisms or suggestions for improving the next edition were received. Revision is now under way and 18 of the original respondents have volunteered to be members of the revision committee. No judgement was made about the non-respondents. CONCLUSION: The largest survey yet conducted of published formulary use in one region elicited the extent of use, type of use, criticisms and suggestions for improvement. These suggestions are being used as a guide to revision of the next edition.

Attitude of Health Personnel↗
PubMed1994

A 'compass' for general practitioner prescribers.

This paper records the result of research and development in interrogating a general practitioner prescription pricing database to provide customised analysis for every practice. The system 'COMPASS' (Computerised On-line Monthly Prescribing Analysed for Science and Stewardship) is described, and identifies instances where each practice might improve cost-effectiveness and scientific rationality in prescribing. One hundred and two such instances are interrogated. This initial COMPASS report is then supplemented by screening the database to show a practice's: 1. range of drugs used--an excessive range should be discouraged. 2. use of drugs often used imprecisely--eg, antibiotics. 3. predicted prescribing cost--based on practice demography. 4. use of drugs with very limited GP value--eg, peripheral vasodilators. Northern Irish fundholding general practitioners are finding COMPASS valuable in planning improvement in cost-effectiveness and quality.

Cost Savings↗
PubMed1993

Market penetration of new drugs in one United Kingdom region: implications for general practitioners and administrators.

OBJECTIVE: To determine the use of new drugs in one United Kingdom region. DESIGN: Examination of data on prescribing of angiotensin converting enzyme inhibitors, new broad spectrum antibiotics, and H2 receptor antagonists. Calculation of number of defined daily doses prescribed each month. SETTING: All general practices in Northern Ireland. MAIN OUTCOME MEASURES: Drug use index and market share of each drug. RESULTS: During 1988-91 prescribing of angiotensin converting enzyme inhibitors increased by 126%, of H2 receptor antagonists by 46%, and of new antibiotics by 207%. The first drug on the market usually retained the largest market share. Use of oral antibiotics increased threefold irrespective of the reporting policy of the general practitioners' local laboratory. CONCLUSIONS: The increase in prescribing of these drugs seems to be greater than can be accounted for by an increase in patients with specific indications for these drugs. This suggests that the profession has not instituted effective checks to ensure that the legitimate promotion of new products does not lead to inappropriate and wasteful use.

Angiotensin-Converting Enzyme Inhibitors↗