Variation in prescription duration for long term conditions: a cohort study in English NHS primary care using OpenPrescribing.

Abstract

Background: Many patients receive routine medications for long-term conditions (LTCs). Doctors typically issue repeat prescriptions in one to three month durations, but England currently has no national guidance on the optimal duration.

Aim: Describe current prescription durations for common LTCs in England, explore and visualise geographical variation, and identify practice factors associated with shorter prescribing duration to inform policy making. Design and Setting A retrospective cohort study of English GP prescribing data December 2018-November 2019 Methods: We calculated the duration of prescriptions for common LTCs in England including the medications ramipril, atorvastatin, simvastatin, levothyroxine and amlodipine . We assessed the level of variation between regional clinical commissioning groups (CCGs) and determined practice factors associated with different durations.

Results: Of the common medications included, 28-day (one-monthly) prescriptions accounted for 48.5% (2.5 billion) tablets/capsules issued, whilst 43.6% were issued for 56 days (two monthly). There was very wide regional variation in the proportion of 28-day prescriptions (7.2% to 95.0%). Practice dispensing status was the most likely predictor of prescription duration. The proportion of patients with LTCs and the electronic health record software used by a practice were also associated with prescription duration.

Conclusions: One month prescription durations are common for patients taking medicines routinely for long term conditions, particularly in dispensing practices. Electronic health record configurations offer an opportunity to implement and evaluate new policies on repeat prescription duration in England.