Appropriate prescribing in asthma and its related cost in east London.
OBJECTIVE
To determine the patterns of preventive to reactive prescribing for asthma among general practices in the City and East London Family Health Services Authority area and their relation to prescribing cost.


METHODS
Descriptive study of asthma prescribing during April 1992 to March 1993. Prescribing data were linked with general practice and population data on one database.


METHODS
City and East London Family Health Services Authority area, including all general practices in contract with the authority, which covers the inner city London Boroughs of Hackney, Tower Hamlets, and Newham and the Corporation of the City of London.


METHODS
All 163 general practices as at 1 June 1993.


METHODS
Ratios of prescribed inhaled corticosteroids plus cromoglycates (prophylactic treatment) to bronchodilators; distribution of the cost of asthma prescribing; distribution of overall generic prescribing; proportion of asthma generic prescribing; distribution of cost of overall drugs prescribed per prescribing unit.


RESULTS
Practices approved for band 3 health promotion or asthma surveillance and those with a general practitioner trainer had on average higher ratios of prophylactic to bronchodilator treatment and significantly higher asthma drug costs than other practices. Those practices with high levels of overall generic prescribing had significantly higher prophylactic to bronchodilator ratios than those with lower levels of generic prescribing. Practices with higher levels of asthma drug generic prescribing also had significantly higher prophylactic prescribing. However, the proportion of generically prescribed asthma drugs was lower than overall generic prescribing. There was no correlation between the ratio of prophylactic to bronchodilator asthma prescribing and the proportion of overall drugs expenditure, but high spending practices spent significantly more on asthma drugs.


CONCLUSIONS
Pressure to reduce the cost of asthma prescribing may lead to a lowering of the ratio of prophylactic to bronchodilator treatments. However, reducing prophylactic prescribing would run contrary to the British Thoracic Society guidelines and might worsen the quality of asthma care.
Department of General Practice and Primary Care, Medical College of St Bartholomew's.
J
J
Naish
P
P
Sturdy
P
P
Toon
D000287:Administration, Topical; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000191:economics; D001249:Asthma / Q000188:drug therapy* / Q000191:economics* / Q000517:prevention & control; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000191:economics; D004205:Cromolyn Sodium / Q000008:administration & dosage / Q000191:economics; D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics* / Q000706:statistics & numerical data; D017723:Drug Utilization Review / Q000191:economics* / Q000706:statistics & numerical data; D016568:Drugs, Generic / Q000008:administration & dosage / Q000191:economics; D005194:Family Practice / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D005938:Glucocorticoids; D006801:Humans; D008131:London; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data
D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D016568:Drugs, Generic; D005938:Glucocorticoids; D004205:Cromolyn Sodium