Overprescribing of potentially harmful medication: an observational study in England's general practice

Tasneem Khan; Bethan Copsey; Paul Carder; Stella Johnson; Mohammed Imran; Kaiwen Wang; Sarah Alderson

doi:10.3399/BJGPO.2023.0156

Overprescribing of potentially harmful medication: an observational study in England's general practice

BJGP Open. 2024 Jan 22:BJGPO.2023.0156. doi: 10.3399/BJGPO.2023.0156. Online ahead of print.

Authors

Tasneem Khan¹, Bethan Copsey², Paul Carder³, Stella Johnson³, Mohammed Imran³, Kaiwen Wang⁴, Sarah Alderson⁵

Affiliations

¹ Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom tasneemkhan@doctors.org.uk.
² Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom.
³ NHS West Yorkshire Integrated Care Board, Leeds, United Kingdom.
⁴ University of Leeds, Leeds, United Kingdom.
⁵ Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.

PMID: 38253399
DOI: 10.3399/BJGPO.2023.0156

Abstract

Background: Overprescribing of potentially harmful medication in UK general practice has a complex association with socioeconomic deprivation.

Aim: To assess trends in general practice prescribing of five high-risk medications and their relationship to deprivation.

Design & setting: We conducted an observational study using general practice data from three English regions with varied socio-demographic factors: West Yorkshire and Harrogate (WY), Black Country and West Birmingham (BC), and Surrey and East Sussex (SE).

Method: Practice-level prescribing data was obtained from 2016-2021 for five drug classes: opioids, hypnotics, gabapentinoids, non-steroidal anti-inflammatory drugs (NSAIDs) and antibacterials. Prescribing trends were demonstrated using a linear model.

Results: Reduction in NSAID, Opioid, Hypnotic and Antibacterial prescriptions, and the increase in gabapentinoid prescriptions, were significant at each financial-year time period. Index of Multiple Deprivation (IMD) was positively associated with all drug classes except antibacterials, which showed a positive association when incorporating the interaction term between IMD and age.When adjusting for IMD and population, region was independently associated with prescribing rate. Compared to WY, IMD had a smaller association with prescribing in BC for NSAIDs (Coefficient -0.01578, P=0.004) and antibacterials (Coefficient -0.02769, P=0.007), whereas IMD had a greater association with prescribing in SE for NSAIDs (Coefficient 0.02443, P<.001), opioids (Coefficient 0.08919 p<.001), hypnotics (Coefficient 0.09038 p<.001), gabapentinoids (Coefficient 0.1095, P<.001) and antibacterials (Coefficient 0.01601, P=0.19).

Conclusion: The association of socioeconomic deprivation with overprescribing of high-risk medication in general practice varies by region and drug type. Geographical location is associated with overprescribing, independent of socioeconomic status.

Keywords: Deprivation; Inequalities; Prescribing.