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An evaluation of the impact of NICE guidance on GP prescribing
Authors: Wathen, Bernard1; Dean, Tara2
Source: British Journal of General Practice, Volume 54, Number 499, February 2004 , pp. 103-107(5)
Publisher: Royal College of General Practitioners
Abstract:
Background: One of the aims of the National Institute for Clinical Excellence (NICE) is to promote faster access to the best treatments. However, there is no published research on the impact that NICE guidance has had on prescribing decisions. Aims: To explore the attitudes of general practitioners (GPs) to NICE guidance and to investigate any changes in prescribing patterns. Design: Descriptive cross-sectional study. Setting: North Devon Primary Care Trust. Method: Five technology appraisals most likely to impact on GP prescribing were investigated. Prescribing analysis and cost (PACT) data were analysed for changes in prescribing patterns before and after the publication of each technology appraisal. A postal questionnaire, developed from semi-structured interviews, was sent to all GPs within a single primary care trust (PCT) to explore factors that were encouraging or discouraging adherence to NICE guidance. Results: PACT data showed that there was an increase in the prescribing of the drugs studied immediately after NICE guidance, with the exception of zanamivir (Relenza® [GlaxoSmithKline]); only one zanamivir inhaler was prescribed during the study period. Although there was an increase in the prescribing of maintenance doses of proton pump inhibitors, there was also an increase in treatment doses. Eighty-one (82.7%) questionnaires were completed and returned. In general, there was a balance between the factors that encouraged and those that discouraged adherence. The main exception was zanamivir, where factors that discouraged adherence greatly exceeded factors that encouraged adherence. Conclusions: This study showed that NICE guidance in isolation had little impact on GP prescribing. Where the guidance coincided with information from other sources, or personal experience, there was some evidence that technology appraisals triggered an increase in prescribing, but that this was not always sustained. The recommendations of NICE concerning zanamivir were universally rejected and there was evidence that this had undermined confidence in NICE recommendations in general.Keywords: CLINICAL PRACTICE GUIDLINES; PRESCRIPTIONS DRUG; PRIMARY HEALTH CARE; TECHNOLOGY ASSESSMENT
Document Type: Research article
Affiliations: 1: Medicines Information and Formulary Pharmacist, North Devon District Hospital, Barnstaple 2: Reader in epidemiology and director of research, Portsmouth Institute of Medicine, Health and Social Care, University of Portsmouth, Portsmouth
Publication date: 2004-02-01
- The British Journal of General Practice is an international journal publishing articles of interest to family practitioners and primary care researchers worldwide. The journal's 2010 Impact Factor is 2.07, making it the world's second most highly cited journal of general practice and primary health care.
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