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October 2021

Harm outweighs benefits overprescribing review finds

At least 10% of current prescribing in primary care is inappropriate, with patients being given medicines they don’t need or want, or where harm outweighs benefits, a government review into overprescribing has concluded.

With 1.1 billion prescription items dispensed each year in primary care and the community, the scale of the problem is ‘unacceptable’, the review found. Although evidence is limited, the review says at least 10% of the total number of prescription items in primary care need not have been issued. But initiatives to, for example, reduce antibiotic prescribing suggest that a reduction in the volume of prescription items of 10% is realistic.

‘Overprescribing’ occurs when a patient is prescribed a drug when there would have been a better alternative, or a medicine which is appropriate for the condition but not for the individual patient, when their condition changes and the drug is no longer appropriate, or when the patient no longer needs or benefits from the drug but continues to be prescribed it.

But the report, ‘Good for you, good for us, good for everybody’ acknowledges that ‘When a clinician issues a prescription, it is usually because they genuinely believe that it is something the patient needs. Overprescribing is rarely the result of a faulty diagnosis. The extent of overprescribing is a result of weaknesses in the healthcare system and culture, not the skills or dedication of individual healthcare professionals.’

Repeat prescriptions make up around 75% of all prescription items, but can continue without review for long periods, increasing the risk of overprescribing. Currently, around 15% of people in England are taking five or more medicines a day, and 7% are on eight or more. In some cases, people are taking one drug to deal with the side effects of another.

Other causes of overprescribing include communication issues between primary care, hospitals and pharmacies, including no record of the clinical indication for which the drug was prescribed by another clinician. Treatment guidelines rarely offer rational alternatives to prescribed medicines, and alternatives such as counselling or physiotherapy may inaccessible or unaffordable.

Among the review’s recommendations are that clinical guidelines should include recommendations for reviewing and discontinuing medicines, and alternatives to medication; the RCGP and Royal Pharmaceutical Society should work together to help practices to improve repeat prescribing processes; and there should be increased use of structured medication reviews (SMRs) by clinical pharmacists to address overprescribing.

Practice Nurse 2021;51(9):8