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GPs accused of dangerous prescribing in thousands of patients

A four-fold variation in the rates of high-risk prescribing has been found among GP practices in Scotland.

Researchers identified 139,404 patients who are particularly vulnerable to adverse drug events at 315 Scottish practices. Of these, 7.9% were defined as particularly vulnerable to adverse drug events because of age, comorbidity, or co-prescription.

The analysis of primary care records showed 13.9% of the vulnerable group - one patient in seven - had been prescribed one or more high-risk medications in the past year.

While some practices issued less than half the expected rate of high-risk prescriptions, others had rates of up to 125 per cent higher than expected.

Researchers defined high-risk prescribing according to 15 indicators, covering NSAIDs, co-prescription with warfarin, heart failure, methotrexate and antipsychotic prescribing in dementia.

Variation between practices in the overall rate of high risk prescribing 'was considerable', ranging from 3.6% of patients receiving at least one high risk prescription to 31.3%, with a median of 12.5%.

Lead author Professor Bruce Guthrie, professor of primary care medicine at the University of Dundee and a GP in the city, stressed that high-risk prescribing is not always inappropriate.

‘Real life prescribing often involves balancing risk and benefit in conditions of uncertainty, and a drug may be high risk but still a rational and reasonable one to prescribe.'

The authors found no link between a low rate of high-risk prescribing and the practice achieving maximum QoF points for the three drug review and medicines improvement indicators.

‘The findings suggest that existing activity to improve prescribing is insufficiently focused on safety, despite the considerable harm caused by prescribing,' said Prof Guthrie.

‘This possibly reflects both the historical background of improving prescribing by focusing on costs and the lack of routinely available indicators of prescribing safety.

‘The current ubiquity of electronic data in UK primary care makes routine measurement of the kind carried out in this study feasible, and it is time to make prescribing safety a priority in primary care.'

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