The relationship between prescribing expenditure and quality in primary care: an observational study.
BACKGROUND
If all GPs target their prescribing appropriately, then a positive relationship may be expected between targeting quality indicators and associated prescribing expenditure. Little is known about this relationship.


OBJECTIVE
To explore the relationship between prescribing quality indicators and associated prescribing expenditures.


METHODS
Observational study of prescribing expenditure and quality indicators.


METHODS
Seventy-one of the 121 practices in the Norfolk and Waveney area of East Anglia in England.


METHODS
Data were collected on quality indicators for 2002-2003 in seven areas likely to produce the greatest number of lives saved over a period of 1 year. This was linked to routine data on associated pharmaceutical expenditure.


RESULTS
There was considerable variation in quality in all areas apart from influenza immunisation. Significant correlations between prescribing quality and expenditure were found in only two of the seven areas. When quality scores were combined into a composite quality index weighted by health gain, a small positive association was found, but this association is lost if all indicators are weighted equally.


CONCLUSIONS
There appeared to be no relationship between quality indicators and prescribing expenditure at the practice level for most of the therapeutic areas studied. This suggests the possibility that there may be scope for some GPs to target prescribing more appropriately towards high risk patients -- and thus save more lives -- without increasing prescribing expenditure.
Fleetcroft
Robert
R
Primary Care Group, University of East Anglia, Norwich, UK. r.fleetcroft@uea.ac.uk
Cookson
Richard
R
D003625:Data Collection; D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics*; D004739:England; D005194:Family Practice / Q000191:economics / Q000592:standards; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards; D019984:Quality Indicators, Health Care