title: Do general practices which provide an acupuncture service have low referral rates and prescription costs? A pilot survey.
abstract: BACKGROUND
  Studies by individual acupuncture practitioners have given an indication that offering acupuncture in primary care may reduce the need for referral to secondary care and reduce the costs of prescriptions. It would be informative to find out whether these findings can be supported by data from other practices. The aim of this study was to test the feasibility of surveying national data on referrals and prescribing.
  
  
  METHODS
  Three primary care trusts (PCTs) were selected, and all practices within each trust were sent an email asking whether any member of the primary care team offered acupuncture, and if so how many appointments per week. Data on rates of referral to orthopaedic, physiotherapy, pain and rheumatology clinics were then sought from the PCT, both for the practices offering acupuncture and for the PCT as a whole. Similarly, data on costs of prescriptions for non-steroidal (NSAID) and non-opioid analgesic drugs were obtained from the Prescription Pricing Authority.
  
  
  RESULTS
  Out of the 109 practices surveyed, a total of 14 (13%) offered acupuncture services to some extent. There was wide variation in provision between the different PCTs. The eight practices which offered at least one appointment per week for every 2000 registered patients were included in the analysis. The mean values (and SDs) for the three PCTs and for the eight acupuncture practices, respectively, were as follows: for referral to various clinics: orthopaedic 32.3 (16.2) and 27.4 (10.87); pain clinic 1.6 (1.3) and 2.8 (1.6); physiotherapy 13.4 (14.5) and 29.5 (10.0); and rheumatology 4.7 (2.3) and 6.4 (3.0). The mean values for costs of non-opioid analgesics were pound1820 ( pound442) and pound2008 ( pound762); and for NSAIDs were pound4148 ( pound269) and pound4476 ( pound1366), respectively. There were no trends towards a reduction of clinic referral or prescription costs.
  
  
  CONCLUSIONS
  We have conducted the first survey of the effects of provision of acupuncture in UK general practice, using data provided by the NHS, and uncovered a wide variation in the availability of the service in different areas. We have been unable to demonstrate any consistent differences in the prescribing or referral rates that could be due to the use of acupuncture in these practices. The wide variation in the data means that if such a trend exists, a very large survey would be needed to identify it. However, we discovered inaccuracies and variations in presentation of data by the PCTs which have made the numerical input, and hence our results, unreliable. Thus the practicalities of access to data and the problems with data accuracy would preclude a nationwide survey.
authors.affiliation: Stopsley Group Practice, Churchfield Medical Centre, Luton, UK. johgina@gmail.com
authors.forename: Gina
authors.initials: G
authors.lastname: Johnson
authors.forename: Adrian
authors.initials: A
authors.lastname: White
authors.forename: Ruth
authors.initials: R
authors.lastname: Livingstone
mesh_terms: D015670:Acupuncture Therapy / Q000191:economics* / Q000706:statistics & numerical data; D000893:Anti-Inflammatory Agents / Q000191:economics; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D019538:Health Care Surveys; D006801:Humans; D059408:Pain Management; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data; D055553:Prescription Drugs / Q000191:economics*; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000191:economics* / Q000706:statistics & numerical data; D013222:State Medicine; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000893:Anti-Inflammatory Agents; D055553:Prescription Drugs