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Are GP practice prescribing rates for coronary heart disease drugs equitable? A cross sectional analysis in four primary care trusts in England
  1. P R Ward1,
  2. P R Noyce2,
  3. A S St Leger3
  1. 1School of Social Science and Law, Sheffield Hallam University, Sheffield, UK
  2. 2School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Manchester, UK
  3. 3Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester
  1. Correspondence to:
 Dr P R Ward
 School of Social Science and Law, Collegiate Crescent Campus, Sheffield Hallam University, Sheffield S10 2BP, UK;


Study objective: To analyse the associations between proxies of healthcare need and GP practice prescribing rates for five major coronary heart disease (CHD) drug groups.

Design: Cross sectional secondary analysis.

Setting: Four primary care trusts (PCTs 1–4) in the north west of England, encompassing 132 GP practices.

Results: Prescribing rates were generally positively associated with the percentage of patients aged 55–74 years and PASS-PUs (regionally specific prevalence, age, and sex standardised prescribing units). However, the percentage of patients aged over 75 years showed a lack of association with prescribing rates in all PCTs other than PCT2. Correlations with the proportion of South Asian patients were generally negative, particularly in PCT2, PCT4, and the combined dataset. There was a general lack of association with deprivation proxies and SMRs for CHD, although there were negative associations with both variables in PCT4 and the combined dataset. Scatter plots showed that GP practices with similar prescribing rates had widely differing levels of comparative healthcare need, and GP practices with similar levels of healthcare need had widely differing prescribing rates.

Conclusion: GP prescribing rates in some PCTs were negatively associated with proxies of healthcare need based on patient age (patients aged over 75 years), ethnicity, levels of deprivation, and SMRs for CHD. As such, this study suggests that prescribing rates in these PCTs may be inequitable as they are not positively associated with healthcare need. This study may form the baseline for further studies to assess the effectiveness of the NSF for CHD in reducing the inequities in prescribing rates.

  • coronary heart disease
  • equity
  • GP prescribing
  • CHD, coronary heart disease
  • PCT, primary care trust
  • NSF for CHD, National Service Framework for coronary heart disease
  • ADQ, average daily quantity
  • HCNI, health care needs indicator
  • LISI, low income scheme index
  • PASS-PU, prevalence, age and sex specific prescribing unit

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  • * The five ACE inhibitors represent the majority of prescribing for all ACE inhibitors.

  • Atenolol represents the majority of prescribing of all β blockers.

  • Co-tenidone is a combination product containing both a β blocker (atenolol) and a diuretic (chlorthalidone).

  • Funding: Paul Ward received a Health Services Research Training Fellowship from the North West NHS Executive to carry out the study on which this paper is based.

  • Conflicts of interest: none declared.

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