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Drive to cut clopidogrel prescribing flawed

A Government push to reduce unnecessary clopidogrel prescribing in primary care may be focusing on the wrong PCTs, researchers warn.

An analysis of an official indicator for judging trust performance shows it may incorrectly identify trusts as high or low users of the drug.

Clopidogrel is one of a number of drugs, among them statins, that the National Audit Office singled out as a potential source of savings, prompting the NHS Institute for Innovation and Improvement to rank trusts into league tables.

PCTs have been quick to target clopidogrel use using drug switching schemes – promoting the use of aspirin instead.

But researchers found NAO calculations of appropriate levels of prescribing failed to take into account a population's age and sex, deprivation, prevalence of CHD or a host of other factors.

According to national data, the number of prescriptions varies widely between the lowest (Torbay) and highest (North Liverpool) PCTs.

The NAO predicted great cost savings could be made if all PCTs could achieve the prescribing levels of the top 25%.

But Study leader Dr Duncan Petty, a lecturer in the school of pharmacy at the University of Leeds, said the NAO indicators should not be used as a ‘league table'.

‘Poor ranking against other PCTs using the NAO indicator should be fully explored taking into account other variables before any corrective action is taken,' he added.

Dr John Ashcroft, a GP in Ilkestone and vascular lead for Derbyshire County PCT, said clopidogrel was an expensive drug and it was sensible to check it was being prescribed appropriately. But he added: ‘The NHS has a habit of taking the average as being right when it's often wrong and not looking at the reasons for variation.'

The research is published online by the Journal of Public Health.

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