Potentially hazardous prescribing is more likely to occur in people taking multiple medicines for long-term conditions, the study found. Older people were also at higher risk of having an unsafe prescription. Younger people with fewer prescriptions were more likely than their older counterparts to be subject to insufficient monitoring.
The high variation between practices in rates of potentially hazardous prescribing revealed by the study indicates that targeted practice-level interventions could provide an approach to reducing such problematic prescribing.
"Prescribing indicators [such as those used in the study] could be used by medicines management and optimisation teams in Clinical Commissioning Groups to improve patient safety, particularly because they can be used to help concentrate resources and efforts on outlier practices," said Dr Martin Duerden, GP and Clinical Senior Lecturer at the Centre for Health Economics and Medicines Evaluation, Bangor University, North Wales.
"The finding that older patients and those receiving multiple repeat prescriptions had the highest risk of triggering a prescribing safety indicator is not surprising," said Dr Duerden. "The message here is for greater vigilance in such patients and increased educational provision for prescribers."
Monitoring younger patients
The discovery that younger patients with fewer repeat prescriptions had higher risk of triggering a monitoring indicator is more surprising, according to Dr Duerden, but may suggest less time or commitment to getting regular blood tests in younger people. "If this is the case, maybe greater effort should be made to emphasise to these people the importance of monitoring, to strengthen recall systems, and to provide these tests at a time that fits into their busy lives," he suggested.
Medicines optimisation guidance from NICE recommends that healthcare professionals consider structured medication reviews for some groups of patients when a clear purpose for the review has been identified. Organisations should also have robust and transparent processes in place (such as the National Reporting and Learning System) to identify, report, prioritise, investigate and learn from medicines-related safety incidents.