High-risk prescribing in an Irish primary care population: Trends and variation

Abstract

Aims

To examine the prevalence of high-risk prescribing (HRP) in community-dwelling adults in Ireland from 2011-2015 using consensus-validated indicators, factors associated with HRP, and variation in HRP between general practitioners (GPs) and dispensing of high-risk prescriptions between pharmacies.

Methods

A repeated cross-sectional national pharmacy claims database study. Prescribing indicators were based on those developed in formal consensus studies and applicable to pharmacy claims data. Multilevel logistic regression was used to examine factors associated with HRP and dispensing.

Results

There were significant reductions in the rates of most indicators over time (P<0.001). 66,022 of 300,906 patients at risk in 2011 (21.9%, 95% CI 21.8-22.1%), and 42,109 of 278,469 in 2015 (15.1%, 95% CI 15.0-15.3%), received ≥1 high-risk prescription (P<0.001). In 2015, indicators with highest rates of HRP were prescription of a non-steroidal anti-inflammatory drug (NSAID) without gastro-protection in those ≥75 years (37.2% of those on NSAIDs), co-prescription of warfarin and an antiplatelet or high-risk antibiotic (19.5% and 16.2% of those on warfarin, respectively), and prescription of digoxin ≥250 mcg/day in those ≥65 years (14.0% of those on digoxin). Any HRP increased significantly with age and number of chronic medications (P<0.001). After controlling for patient variables, and GP, the variation in rate of HRP between GPs, and dispensing of high-risk prescriptions between pharmacies, respectively, was significant (P<0.05).

Conclusions

HRP in Ireland has declined over time although some indicators persist. The variation between GPs and pharmacies suggests potential for improvement in safe medicines use in community care, particularly in vulnerable older aged populations.

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