The relationship between prescribing expenditure and quality in primary care: an observational study

Background: If all GPs target their prescribing appropriately, then a positive relationship may be expected between targeting quality indicators and associated prescribing expenditure. Little is known about this relationship.

Aim: To explore the relationship between prescribing quality indicators and associated prescribing expenditures.

Design: Observational study of prescribing expenditure and quality indicators.

Setting: Seventy-one of the 121 practices in the Norfolk and Waveney area of East Anglia in England.

Method: Data were collected on quality indicators for 2002-2003 in seven areas likely to produce the greatest number of lives saved over a period of 1 year. This was linked to routine data on associated pharmaceutical expenditure.

Results: There was considerable variation in quality in all areas apart from influenza immunisation. Significant correlations between prescribing quality and expenditure were found in only two of the seven areas. When quality scores were combined into a composite quality index weighted by health gain, a small positive association was found, but this association is lost if all indicators are weighted equally.

Conclusions: There appeared to be no relationship between quality indicators and prescribing expenditure at the practice level for most of the therapeutic areas studied. This suggests the possibility that there may be scope for some GPs to target prescribing more appropriately towards high risk patients — and thus save more lives — without increasing prescribing expenditure.