Primary care academics have called for practices to monitor their individual GPs’ prescribing, so as not to miss repeated high-risk prescribing that may not show up by looking at a practice’s overall prescribing safety record.
Their research suggested that the majority of high-risk prescribing by GPs is masked by better prescribing practice of their colleagues.
The team, led by Professor Bruce Guthrie, professor of primary care at the University of Dundee, studied prescribing data from 38 GP practices in Scotland, and found rates of high-risk prescribing of NSAIDs varied much more between GPs than between the practices.
Overall, such high-risk prescribing was low, occurring in 1% of all potential encounters with patients who would be particularly vulnerable to NSAID adverse drug effects.
But rates were as high as 20% for individual GPs, compared with just under 4% for practices.
Statistical models showed that three times more variation in high-risk prescribing was down to the variation between GPs than the variation between practices.
The researchers concluded that ‘high-risk prescribing is more of a “bad apple” than a “spoiled barrel” problem’ and that ‘only targeting practices with higher than average rates will miss most high-risk NSAID prescribing’.
They said that prescribing safety improvement should target all practices, but should also ‘encourage practices to consider and act on variation between prescribers in the practice’.