Retrospective, multicohort analysis of the Clinical Practice Research Datalink (CPRD) to determine differences in the cost of medication wastage, dispensing fees and prescriber time of issuing either short (<60 days) or long (≥60 days) prescription lengths in primary care for common, chronic conditions in the UK.

OBJECTIVES: To investigate patterns of early repeat prescriptions and treatment switching over an 11-year period to estimate differences in the cost of medication wastage, dispensing fees and prescriber time for short (<60 days) and long (≥60 days) prescription lengths from the perspective of the National Health Service in the UK. SETTING: Retrospective, multiple cohort study of primary care prescriptions from the Clinical Practice Research Datalink. PARTICIPANTS: Five random samples of 50 000 patients each prescribed oral drugs for (1) glucose control in type 2 diabetes mellitus (T2DM); (2) hypertension in T2DM; (3) statins (lipid management) in T2DM; (4) secondary prevention of myocardial infarction; and (5) depression. PRIMARY AND SECONDARY OUTCOME MEASURES: The volume of medication wastage from early repeat prescriptions and three other types of treatment switches was quantified and costed. Dispensing fees and prescriber time were also determined. Total unnecessary costs (TUC; cost of medication wastage, dispensing fees and prescriber time) associated with <60 day and ≥60 day prescriptions, standardised to a 120-day period, were then compared. RESULTS: Longer prescription lengths were associated with more medication waste per prescription. However, when including dispensing fees and prescriber time, longer prescription lengths resulted in lower TUC. This finding was consistent across all five cohorts. Savings ranged from £8.38 to £12.06 per prescription per 120 days if a single long prescription was issued instead of multiple short prescriptions. Prescriber time costs accounted for the largest component of TUC. CONCLUSIONS: Shorter prescription lengths could potentially reduce medication wastage, but they may also increase dispensing fees and/or the time burden of issuing prescriptions.This research was supported by a grant from the National Institute for Health Research, Health Technology Assessment funding stream (Grant Reference: NIHR HTA 14/159/07)

Rapid prioritisation of topics for rapid evaluation: the case of innovations in adult social care and social work.

BACKGROUND: Prioritisation processes are widely used in healthcare research and increasingly in social care research. Previous research has recommended using consensus development methods for inclusive research agenda setting. This research has highlighted the need for transparent and systematic methods for priority setting. Yet there has been little research on how to conduct prioritisation processes using rapid methods. This is a particular concern when prioritisation needs to happen rapidly. This paper aims to describe and discuss a process of rapidly identifying and prioritising a shortlist of innovations for rapid evaluation applied in the field of adult social care and social work. METHOD: We adapted the James Lind Alliance approach to priority setting for rapid use. We followed four stages: (1) Identified a long list of innovations, (2) Developed shortlisting criteria, (3) Grouped and sifted innovations, and (4) Prioritised innovations in a multi-stakeholder workshop (n = 23). Project initiation through to completion of the final report took four months. RESULTS: Twenty innovations were included in the final shortlist (out of 158 suggested innovations). The top five innovations for evaluation were identified and findings highlighted key themes which influenced prioritisation. The top five priorities (listed here in alphabetical order) were: Care coordination for dementia in the community, family group conferencing, Greenwich prisons social care, local area coordination and MySense.Ai. Feedback from workshop participants (n = 15) highlighted tensions from using a rapid process (e.g. challenges of reaching consensus in one workshop). CONCLUSION: The method outlined in this manuscript can be used to rapidly prioritise innovations for evaluation in a feasible and robust way. We outline some implications and compromises of rapid prioritisation processes for future users of this approach to consider

Patterns of General Practice prescribing in the last year of life

Background: Little is known about patterns of prescribing in the last year of life in primary care. Methods: Recently completed analysis of UK Clinical Practice Research Datalink (CPRD), a large database extracted from GP records that is representative of the UK population. Prescribing data for the last 12 months of life were extracted from 118,571 patients’ GP records who died between September 2010 and August 2015. Two clinicians used British National Formulary codes to identify eight palliative care drug categories: antiemetics, anti-secretory, benzodiazepines, steroids, strong injectable opioids, strong patch opioids, strong enteral opioids, and weak oral opioids. The percentage of patients prescribed each medications was calculated at weekly intervals during the year before death, further stratified by cause of death and age at death. Random effects logistic regression models were run adjusted for age-group, sex, and cause of death. Results: Levels of prescribing significantly increased for all drugs at time of death compared with one year before death (with the exception of weak oral opioids and steroids where results were inconsistent across ages, genders, and causes of death). The largest increase was for 90+ year old male patients prescribed strong injectable opioids (OR: 21032, 95% CI: 3499-12641) and the greatest decrease for females prescribed steroids who died of external causes (OR: 0.52, 95% CI 0.34-0.70). Patients who died of cancer generally showed the most marked increase in prescribing towards the end of life compared with other causes of death. Conclusions: Primary care patterns of prescribing in the last year of life has not been previously investigated. The findings of this recently completed study of a large nationally-representative dataset reveal increasing GP prescribing in response to the rising symptom burden of all patient groups as death approached. The implications for clinical practice and future research will be discussed