Abstract
Aim: to understand the potential impact of electronic repeat dispensing (eRD) on the volume of medicines utilised, and hospital admissions.
Method: All GP practices in England were analysed to determine the % eRD implementation (items) in both 2017/18 and 2022/23. Two cohorts of GP practices were then defined; <1% eRD (control group) and >50% eRD (intervention group), in 2022/23. The ‘defined daily dose (DDD) per identified patient prescribed a specific drug group’ was then calculated using primary care dispensed medicines data1 for the most common BNF paragraphs prescribed by eRD: lipid-regulating drugs (LRDs), proton pump inhibitors (PPIs), renin-angiotensin system (RAS), beta-adrenoceptor blockers (BB), calcium channel blockers (CCBs), antidiabetic (AD) and antiplatelet (AP) drugs. The statistical significance between the DDDs/patient in the control and intervention groups were analysed at both time points, using a 2 tailed T-test. Hospital admissions for gastro-intestinal (GI) bleeds, stroke and myocardial infarction (MI) were obtained from the Hospital Episode Statistics data warehouse2, for the two time periods for both cohorts. The admissions were weighted by the cohort list size and scaled to admissions per 100,000 population.
Results: There were ~1300 GP practices in the control group (<1% eRD) and ~200 GP practices in the intervention group (>50% eRD). In 2017/18, there was no significant difference in the average volume of drug a patient received (DDD/identified patient) between the control and intervention groups for all the BNF groups analysed, with the exception of PPIs. At the outset, the intervention group had a significantly lower volume of PPI prescribing per patient and higher admissions for GI bleeds (474 versus 434 per 100,000 people). In 2022/23, the weighted volume of prescribing of PPIs in the control group remained unchanged, whereas there was a significant increase in the intervention group to 215 DDD/patient (control group 229 DDD/patient). In 2022/23, the number of hospital admissions for GI bleeds had reduced by 62 and 17 admissions per 100,000 list size, for the intervention and control groups respectively, relative to the 2017/18 baseline. For the cardiovascular drug groups; AP, CCBs and LRDs, there was a significant increase in volume per patient over time in the intervention cohort only. Hospital admissions for stroke were unchanged, however, admissions for MI reduced in both cohorts to 49 and 67 admissions per 100,000 list size for the intervention and control group respectively. The volume of BBs decreased in both groups over time and there was no significant change in RAS drug volume.
Conclusion: The data suggests that in GP practices with higher levels of eRD implementation, the volume of drug per patient dispensed may increase for specific drug groups. This was associated with a reduction in hospital admissions for GI bleeds and MIs. Further analysis using linked patient data is suggested, to confirm the improved outcomes are attributable to the changes in prescribing volume.