PITCH: A descriptive study of repeat prescribing systems in general practices recruited for the SPPiRE trial

Problem

The problem

Repeat prescribing forms a considerable bulk of work in day to day general practice. It has been estimated that if all indirect repeat prescriptions were replaced with face to face consultations an average five partner practice would need to employ an additional full time GP. Despite the cost and time saving benefits of repeat prescribing, the process results in an increased potential for errors. The Irish College of General Practitioners has developed a guideline with specific recommendations on how repeat prescriptions should be managed in practice but little is known about current repeat prescribing practices in Irish primary care and whether or not these guidelines are adhered to.

Approach

This descriptive study uses data from an on-going cluster randomised trial that is assessing the effectiveness of a web guided medication review in reducing polypharmacy and potentially inappropriate prescribing in older patients with multimorbidity (SPPIRE trial). Practices registered with the Irish Primary Care Clinical trials network were invited to participate. Recruited practices completed a practice profile questionnaire providing information on practice size, organisation and repeat prescribing policies. Descriptive statistics on recruited practices are presented.

Findings

Fifty three general practices across the Republic of Ireland provided practice prescribing information as part of the process recruitment for the SPPiRE trial. These practices are larger than the national average with 40% compared to 19% having four or more GPs. There is a similar spread in terms of location; 43% of SPPiRE practices are located in urban areas, compared to 42% of national practices. Less than half have written repeat prescribing (41.5%) or adverse incident policies (45.3%). The median amount of time spent per GP per day managing repeat prescriptions is 30 minutes (IQR 20). When comparing practices that do and don’t have a written repeat prescribing policy, there is no difference in terms of size, having a practice manager or the time spent managing repeat prescription requests. Practices that have a written repeat prescription policy are almost three times more likely to use a standardised request form.

Consequences

This study demonstrates significant variation in repeat prescribing policies in recruited SPPiRE practices in Ireland. These practices are larger than the national average and have at least one GP who has expressed an interest in participating in a prescribing study. The current GP contract does not cover chronic disease management apart from a recently introduced system for diabetes and practices have also had a 38% reduction in funding during the recent recession. In this context of largely reactive care, the majority of these practices are not adhering to the ICGP repeat prescribing guideline. Further qualitative work in this area may give an insight into the barriers and facilitators of implementing these guidelines.