Introduction: In 2024, the repeat prescribing toolkit was launched (RPS/RCGP), to improve consistency in repeat prescribing processes, which includes electronic repeat dispensing (eRD). The toolkit links to resources and guides to support the process within systems. Despite high electronic prescription service utilisation rates in England (92.6%, Dec 2024), the eRD utilisation rate remains low (15.7%, Dec 2024).1 Preliminary study by the Regional Drug and Therapeutic Centre (RDTC) identified 8 thresholds (changes in rate of eRD implementation) which occurred at 3, 9, 35, 42, 50, 57, 64 and 72% eRD uptake, which may be indicative of barriers to implementation.2 There is limited clinical guidance on medicines’ suitability for eRD. However, exclusion criteria lists controlled drugs, benzodiazepines, hypnotics, unlicensed medicines and medication requiring frequent reviews/careful monitoring (e.g.. methotrexate and lithium) as unsuitable.3
Aim: To identify a clinical medicines roadmap, based on current national repeat prescribing practice, that could be used to support GP practices in increasing implementation of electronic repeat dispensing (eRD).
Method: Dispensed medicines data5 (Oct-Dec 22) was analysed by medicine type e.g. beta blocker, for the GP practices in England at the 8 identified eRD uptake thresholds (Nettleton et al., 20234). Pearsons correlation coefficient was used to identify medicines that displayed a linear relationship between the thresholds and %eRD uptake in that specific medicine. Linear trends were considered to represent continuous uptake and therefore not subject to barriers to eRD implementation in practice. Medicines with non-linear (polynomial) trends were analysed further to determine the %eRD threshold at which the rate of uptake was highest, indicative of overcoming a barrier. Data outliers were identified and excluded using the statistical method of 1.5 x Interquartile range. Significance of the change in eRD implementation rate between thresholds was quantified using ANOVA and T.tests (2 tailed).
Results: The majority of medicine types displayed either a linear relationship or a polynomial trend where uptake started at a higher rate and then reduced, indicative of no barrier to implementation. However, specific medicines increased rapidly in eRD uptake at defined thresholds; such as Loop diuretics (3%), Antimuscarinic bronchodilators (35%), drugs for Erectile dysfunction (35%), Compound bronchodilator preparations (42%), Anxiolytics (42%), Glucocorticoid therapy (50%), Rheumatic disease suppressant drugs (50%), Hypnotics (57%) and Non-opioid analgesics & compound preparations (57%). With the exception of hypnotics and non-opioid analgesics, where there was insufficient volume of data, the thresholds for the other named medicines groups were statistically significant (p<0.05). There was also some use of eRD identified for medicines that are considered to be excluded in guidance, e.g. hypnotics and medicines requiring frequent and careful monitoring.
Conclusion: Sharing best practice and guidance to support eRD implementation should include clinical considerations and procedures for the identified medicines with a barrier threshold to uptake. Further clinical guidance should also address the use of eRD for medicines not recommended to be supplied through this route.