Rational prescribing: proton pump inhibitor audit and re-audit using pharmacist support in one primary care group


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Abstract

AimTo describe the use of practice support pharmacists to audit proton pump inhibitor (PPI) prescribing in one primary care group (PCG) and to determine whether this intervention was effective in assisting practices make prescribing savings.MethodFifteen practices in the West Northumberland PCG were invited to participate in the PPI audit; the PCG prescribing adviser coordinated the project. Practice support pharmacists were employed on a sessional basis, funded by top-slicing our prescribing budget. Patients on PPIs were identified and their records reviewed. Recommendations for change were made and medication reviews encouraged. A re-audit was carried out after one year.ResultsThis project introduced primary healthcare teams to the work of practice support pharmacists, and established the process of audit and re-audit. Fourteen of the 15 practices participated in the study. In total, 1523 patients were taking PPIs out of a population of 72 730 (2.1%). Dose reductions were recommended by the pharmacists for 851 (65%) of patients on PPIs; 508 (60%) eligible cases had their dosage reduced and 377 (74%) of these remained on the reduced dose after one year. These changes represent a financial saving over one year on the PCG prescribing budget of £73 394 and a reduction of 13.5% in the total PPI prescribing costs. The cost of pharmaceutical support was £19 075. The extra work generated by this audit for GPs was costed at £7473. This resulted in a net saving in the first year of £46 846.ConclusionAudit involving practice support pharmacists is effective in promoting rational prescribing with considerable savings in drug expenditure. Primary care organisations should invest in pharmacist support to practices as a means of managing scarce resources.

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