How has fundholding in Northern Ireland affected prescribing patterns? A longitudinal study.
OBJECTIVE
To compare prescribing patterns in general practices before and after the introduction of fundholding in April 1993 to determine whether fundholding changed prescribing patterns among practices that joined the scheme.


METHODS
Analysis of prescribing data from the Drug Utilisation Research Unit's database for all practices in Northern Ireland during April 1989 to March 1996.


METHODS
Northern Ireland.


METHODS
23-first wave fundholders, 34 second wave fundholders, 9 third wave fundholders, and 268 non-fundholders.


METHODS
Prescribing costs per 1000 patients, prescription items per 1000 patients, average cost per item, and rate of generic prescribing.


RESULTS
Prescribing costs and frequency increased in all groups throughout the study. Among the fundholders the rate of increase in costs after fundholding was significantly lower than among non-fundholders. The rate of increase in cost per item fell, coinciding with a significant increase in the rate of generic prescribing. However, with regard to first wave fundholders, their yearly increase in costs in their third year as fundholders (1995-6) was similar to that of the non-fundholders. The earlier practices that joined the scheme seemed to differ in some important respects from those that joined later.


CONCLUSIONS
After fundholders joined the fundholding scheme their patterns of prescribing changed compared with those of non-fundholders: the rate of increase in costs fell and there was a significant rise in the rate of generic prescribing.
Rafferty
T
T
Department of Therapeutics and Pharmacology, Queen's University of Belfast.
Wilson-Davis
K
K
McGavock
H
H
D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics*; D016568:Drugs, Generic / Q000191:economics; D005194:Family Practice / Q000191:economics / Q000639:trends*; D005376:Financial Management; D006801:Humans; D008137:Longitudinal Studies; D009660:Northern Ireland; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends*
D016568:Drugs, Generic