Prevalence ofpotentially inappropriate longterm prescribing in general practiceintheUnitedKingdom,1980-95: systematic literature review

Objective-To determine theprevalence of potentially inappropriate longtermprescribing in general practice intheUnited Kingdom. Design-Review of62studies oftheappropriatenessofprescribing identified fromseven electronic databases, fromreference lists, andby handsearching ofjournals. A nominal groupof10 experts helped todefine theappropriateness of prescribing. Setting-General practice intheUnitedKingdom. Mainoutcomemeasures-Prevalences of19indicators ofinappropriate longtermprescribing representing five dimensions: indication, choice of drug,drugadministration, communication, and review. Results-Prevalences ofpotentially inappropriateprescribing varied byindicator andchronic condition, butdrugdosages outside thetherapeuticrangeconsistently recorded thehighest rates. Thelowest ratesweregenerally associated with indicators ofthechoice ofthedrug,except cost minimisation. Communication isstudied less frequently thanotherdimensions ofprescribing appropriateness. Conclusions-The evidence baseto support allegations ofwidespread inappropriate prescribingingeneral practice isunsound. Although inappropriate prescribing hasoccurred, thescale of theproblem isunknownbecause oflimitations associated withselection ofastandard, publication bias,and uncertainty aboutthecontextof prescribing decisions. Opportunities forcostsavingsandeffectiveness gains arethusunclear. Indicators applicable toindividual patients couldyield evidence ofprescribing appropriateness.