title: Correlation between prescribing quality and pharmaceutical costs in English primary care: national cross-sectional analysis.
abstract: BACKGROUND
  Both pharmaceutical costs and quality-indicator performance vary substantially between general practices, but little is known about the relationship between prescribing costs and quality.
  
  
  OBJECTIVE
  To measure the association between prescribing quality and pharmaceutical costs among English general practices.
  
  
  METHODS
  Cross-sectional observational study using data from the Quality and Outcomes Framework and the Prescribing Analysis and Cost database from all 8409 general practices in England in 2005-2006.
  
  
  METHODS
  Correlation between practice achievement of 26 prescribing quality indicators in eight prescribing areas and related pharmaceutical costs was examined.
  
  
  RESULTS
  There was no significant association between the overall achievement of quality indicators and related pharmaceutical costs (P= 0.399). Mean achievement of quality indicators across all eight prescribing areas was 79.0% (standard deviation 4.4%). There were small positive correlations in five prescribing areas: influenza vaccination, beta blockers, angiotensin converting enzyme inhibitors, lipid lowering, and antiplatelet treatment (all P<0.001). There were small negative correlations in two prescribing areas: hypertension (P<0.001) and smoking cessation (P = 0.018).
  
  
  CONCLUSIONS
  Correlations between prescribing quality and pharmaceutical costs were much smaller than expected; possible explanations for this include a substantial variation in rates of prescribing outside evidence-based protocols, and use of expensive pharmaceuticals instead of cheaper effective alternatives. There remains considerable scope for some practices to make pharmaceutical cost savings while improving quality performance. The ratio of quality scores to related pharmaceutical costs could be developed into a performance indicator.
authors.affiliation: Primary Care Group, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich.
authors.forename: Robert
authors.initials: R
authors.lastname: Fleetcroft
authors.forename: Richard
authors.initials: R
authors.lastname: Cookson
authors.forename: Nicholas
authors.initials: N
authors.lastname: Steel
authors.forename: Amanda
authors.initials: A
authors.lastname: Howe
mesh_terms: D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D016527:Drug Costs; D004739:England; D005194:Family Practice / Q000191:economics* / Q000592:standards; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000592:standards; D055553:Prescription Drugs / Q000191:economics*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care
chemical_list: D055553:Prescription Drugs