A Single General Practice Study involving Clinical Indications on Repeat PrescriptionsNigel Masters and Benjamin Masters –this version April 2006
BackgroundThere is much evidence that poor compliance with statin therapy is normal in clinical practice (1). Indication labelling on prescription may help statin drug adherence and a small practice survey was carried out to check this assumption. The practice has high levels of clinical indication recording of 85% over a two year period with the phrase “to prevent heart attacks and strokes” attached to all statin scripts.
AimAre there high levels of statin drug compliance when there are high levels of clinical indications on repeat scripts?
SettingA suburban practice with a list of 5,800 patients, mainly owner occupiers.
MethodA computer search of all patients at the practice who had taken a statin (atorvastin or simvastatin) over the last year (January 2005) was produced. Patients were simply picked from the list alphabetically. Inclusion criteria was that they had more than one year of repeat prescriptions and a strong indication (both secondary and primary), but were not part of a dose monitored system. A tablet count and a check on cholesterol levels were made on one hundred consecutive patients who fitted the inclusion criteria. Some non-compliant patients will have been excluded as they will not have taken a full year of tablets, but our cardiac Quality and Outcomes data shows that the practice reaches maximum target in all domains with minimal use of exclusion coding. One hundred patients who had taken six two-monthly prescriptions for a statin had days counted to obtain levels of drug compliance. The count was taken from the repeat prescription counter software within the Isoft Premiere computer system. Percentage compliance was calculated as the number of tablets received divided by the number of days taken to complete the course multiplied by 100.
ResultsAverage age of patients in the study was 68 years. The average percentage of compliance of patients over one year of prescriptions was 93%. The average cholesterol reading of these patients was 4.3 mmol/L. Cholesterol levels were only available for 65 out of the 101 patients who were part of the survey. This study was repeated in January 2006 and the compliance remained high at 91% and average cholesterol at 4.3 mmol /L.
DiscussionCompliance with medication is important but can be difficult to research as it is difficult to exclude confounding variables (2). The high levels of compliance seen at this practice could be due to the enthusiasm of the doctors and the nurses. It could be due to patient understanding and behaviour. It could be due to cost-free prescriptions. In addition it could be due clinical indications on repeat prescriptions which provide information and reinforcement and additional supervision and support for the message (e.g. pharmacist and carer) within the standard primary care setting.
ConclusionAt this single practice there is a high level of statin drug compliance. The practice also has high levels of clinical indications on repeat prescriptions. It suggests that these two features may be linked, but prospective studies with controls should be undertaken to see if this innovation really does improve drug adherence.
ReferencesPatient compliance with statins. Bandolier Journal2. Haynes RB ,McDonald H , Garg AX, Montague P.Interventions for helping patients to follow prescriptions for medicationsThe Cochrane Database of Systemic Reviews 2002 Issue 2 Art No CD000011 DOI 10.1002/14651858.CD000011Nigel Masters MRCGP, General PractitionerHighfield Surgery, Highfield Way, Hazlemere, High Wycombe, HP15 7UWBenjamin Masters, Medical StudentUniversity of Southampton