Influencing prescribing in English primary care: the views of primary care organisations.
OBJECTIVE
The rapid rise of prescribing expenditure is a concern in many industrialised countries and methods to manage medicines are widely employed. The purpose of this study was to identify the approaches to improve primary care prescribing by primary care organisations (PCOs) in the National Health Service (NHS) in England.


METHODS
A questionnaire (Management of Medicines, MANMED) was mailed to prescribing advisers and prescribing leads in 332 PCOs.


RESULTS
A response rate of 66% (220/332) was achieved. Most PCOs report the improvement of the quality of prescribing as their top priority, followed by budget adherence at both practice and PCO levels. Prescribing advisers typically offer several forms of support: practice visits, prescribing reviews, indicators of prescribing, prescribing newsletters, hands-on support, seminars and local formularies. PCOs are pursuing a wide range of prescribing initiatives, covering, on average, seven different therapeutic areas. National targets are the main driver for prescribing initiatives but other key influences include inappropriate prescribing and clinical governance. Although cost considerations are important, improving the quality of prescribing is perceived as the overriding principle on which PCO prescribing strategy is based. Multifaceted prescribing support is widespread and national targets are the largest single factor influencing choice of therapeutic area for prescribing initiatives.


CONCLUSIONS
Diversity in approaches presents the opportunity to improve the evidence base for medicines management. Not only could such research inform PCOs in their central aim of improving the quality of prescribing within the NHS, but it may also offer insights of relevance to other countries if the influence of process and context upon the effectiveness of medicines management is systematically explored.
Mason
Anne
A
Centre for Health Economics, University of York, York, UK.
Drummond
Michael
M
Towse
Adrian
A
Cooke
Jonathan
J
D002017:Budgets; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000191:economics / Q000592:standards*; D017723:Drug Utilization Review; D005569:Formularies as Topic; D019538:Health Care Surveys; D006801:Humans; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics / Q000592:standards*; D012959:Socioeconomic Factors; D013222:State Medicine / Q000191:economics / Q000592:standards; D011795:Surveys and Questionnaires; D006113:United Kingdom