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Electronic Letters to:

Original Papers:
David J Heaney, Jeremy J Walker, John GR Howie, Margaret Maxwell, George K Freeman, Peter NE Berrey, Tom G Jones, Morag C Stern, and Stephen M Campbell
The development of a routine NHS data-based index of performance in general practice (NHSPPI)
Fam. Pract. 2002; 19: 77-84 [Abstract] [Full text] [PDF]
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[Read eLetter] Some practical points relating to prescribing quality
Hendrik J Beerstecher   (11 October 2005)

Some practical points relating to prescribing quality 11 October 2005
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Hendrik J Beerstecher,
GP principal
111 Canterbury Road, Sittingbourne, Kent, ME10 4JA

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Re: Some practical points relating to prescribing quality

Dear Editor,

Can I offer some practical advice from personal experience for the future use and development of prescription items as quality indicators.

In Appendix 1 the percentage of 4-Quinolones to all antibiotics will depend on the total antibiotics prescribed. If a high proportion of inappropriate antibiotics is used, for instance penicillins for viral disease, the proportion of Quinolones will be low, even if these are prescribed inappropriately too. The same argument applies to the percentage of antibiotics in the top 10. For antibiotics the absolute prescribing rate is a better indicator at practice level.

The cough suppressants and decongestants are probably related to deprivation and the wide variation in table 1 could represents practice policy. I know of GPs not prescribing these items on principle and expecting the patients to buy these over the counter (OTC). The OTC rate will be higher in any case in affluent areas because the cost of the prescription charge outweighs the cost of the medication.

Statins might not be prescribed appropriately in affluent areas (indicator 9). Anecdotally, having worked in both affluent and deprived areas, rates of inappropriate primary prevention will be higher in affluent areas.

HRT rates (indicator 10) show how time can influence results, high rates over the age of 50 represent poor prescribing now. Compound diurectics (3) can well be related to physician age and foreign medical graduation.

Indicator 15 in Appendix 1 is a measure of practice size and not of quality. Regression to the mean will have a large influence on this indicator.

Indicator 16, staff budget, is probably an indicator of deprivation and location at regional level rather than one of quality. At practice level this would have to be corrected for these factors (London weighting). Perhaps staff composition and hours are a better indicator at practice and regional level.

Conflict of Interest:

None declared