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Townsend et al. provide rich description of how adults with multiple
morbidities use their prescribed drugs in ways that vary considerably from
that intended by their physicians. Practising clinicians are aware that
this is a significant issue for many of their patients though the extent
of multiple comorbidities is less certain. The Tayside Script Facility
in the Medicines Monitoring Unit (MEMO) is a unique to the UK data source
that allows us to know the extent of dispensed prescribing in the Tayside
population for a variety of health problems so setting the recent BMJ
paper in context.
The study population for this analysis was the fixed NHS population
of people over 16 years of age who were registered with a GP in Tayside on
the 1st April 2000 and were still resident as of end March 2001 (n= 370
000) As a region, Tayside has 73 GP practices, two main hospitals-
Ninewells and Perth Royal Infirmary and is covered by two NHS Trusts.
The dispensed prescribing dataset is generated in MEMO from the original
paper prescriptions by exchanging the persons name and address for their
CHI number. Validity is maintained by a routine 1% double entry. The
dataset has, since 1993, covered all BNF categories and so provides a
record of prescription items redeemed by each individual.
The use of the CHI number is a means only of assembling the relevant
data as no research analysis takes place until the data is de-identified
in accordance with local Caldicott guardian requirements. This de-
identification removes all possible identifiers including names,
addresses, GP and Pharmacy codes and generates a pseudoanonymised CHI.
This analysis is based upon the cohort of men and women who have
received a dispensed NHS prescription for an item from the BNF categories
of drugs used in diabetes, asthma, depression, cardiovascular disease and
those using analgesics or antibiotics. The analysis used periods of 3
months in which a prescription for another BNF category medication could
have been redeemed.
During the year of study the numbers of patients with: Diabetes was 9985,
with 5000-5500 patients issued a prescription in any individual month
(PTM);
AND treated for asthma, 1450 in year, 500-600 PTM;
AND treated for depression, 390 in year, 170-190 PTM;
AND treated for cardiovascular disease, 257 in year, 150-170 PTM;
AND treated with Analgesics, 211 in year,112-120 PTM;
AND treated with an antibiotic 181 in year, 44-57 PTM.
The table below summarises the extent of prescribing for
comorbidities based on these data and extrapolates the data to the
population of Scotland (5M).
Treatment Category % of patients
treated for diabetes
Managing multiple morbidity in mid-life is a common, complex issue
which requires further study to ascertain whether the additional risks are
outweighed by the potential benefits for individual patients. For every
complex prescribing problem there is a simple answer, but it may well be
wrong for any individual person.
References
Townsend A, Hunt K, Wyke S. Managing multiple morbidity in mid-life:
a qualitative study of attitudes to drug use. BMJ 2003;327:837
Evans JMM, McDevitt DG, MacDonald TM. The Tayside Medicines
Monitoring Unit (MEMO): A record-linkage system for pharmacovigilance.
Pharmaceut Med 1995; 9:177-184.
Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more
than 80%. BMJ. 2003; 326: 1419
Competing interests:
None declared
Competing interests:
No competing interests
21 October 2003
Frank M Sullivan
NHSTayside Prof of R&D in GP and PC
John Parkinson, Philip Thomson P, Tom Love
Health Informatics Centre, Cummunity Health Sciences, University of Dundee DD2 4BF
Quantification of the extent of prescribing for comorbidity in the MEMO database
Editor,
Townsend et al. provide rich description of how adults with multiple
morbidities use their prescribed drugs in ways that vary considerably from
that intended by their physicians. Practising clinicians are aware that
this is a significant issue for many of their patients though the extent
of multiple comorbidities is less certain. The Tayside Script Facility
in the Medicines Monitoring Unit (MEMO) is a unique to the UK data source
that allows us to know the extent of dispensed prescribing in the Tayside
population for a variety of health problems so setting the recent BMJ
paper in context.
The study population for this analysis was the fixed NHS population
of people over 16 years of age who were registered with a GP in Tayside on
the 1st April 2000 and were still resident as of end March 2001 (n= 370
000) As a region, Tayside has 73 GP practices, two main hospitals-
Ninewells and Perth Royal Infirmary and is covered by two NHS Trusts.
The dispensed prescribing dataset is generated in MEMO from the original
paper prescriptions by exchanging the persons name and address for their
CHI number. Validity is maintained by a routine 1% double entry. The
dataset has, since 1993, covered all BNF categories and so provides a
record of prescription items redeemed by each individual.
The use of the CHI number is a means only of assembling the relevant
data as no research analysis takes place until the data is de-identified
in accordance with local Caldicott guardian requirements. This de-
identification removes all possible identifiers including names,
addresses, GP and Pharmacy codes and generates a pseudoanonymised CHI.
This analysis is based upon the cohort of men and women who have
received a dispensed NHS prescription for an item from the BNF categories
of drugs used in diabetes, asthma, depression, cardiovascular disease and
those using analgesics or antibiotics. The analysis used periods of 3
months in which a prescription for another BNF category medication could
have been redeemed.
During the year of study the numbers of patients with: Diabetes was 9985,
with 5000-5500 patients issued a prescription in any individual month
(PTM);
AND treated for asthma, 1450 in year, 500-600 PTM;
AND treated for depression, 390 in year, 170-190 PTM;
AND treated for cardiovascular disease, 257 in year, 150-170 PTM;
AND treated with Analgesics, 211 in year,112-120 PTM;
AND treated with an antibiotic 181 in year, 44-57 PTM.
The table below summarises the extent of prescribing for
comorbidities based on these data and extrapolates the data to the
population of Scotland (5M).
Treatment Category % of patients
treated for diabetes
% of patients treated for asthma
% of patients treated for depression
Estimated numbers of patients in Scotland
Diabetes
100
134 500
Diabetes + Asthma
14.5
100
19 500
Diabetes + Asthma + Depression
3.9
27
100
5 500
Diabetes +Asthma + Depression +
Cardiovascular disease
2.6
18
66
3 500
Diabetes +Asthma + Depression +
Cardiovascular disease +Analgesia
2.1
14
54
2 850
Diabetes +Asthma + depression +
Cardiovascular disease + Analgesia + Antibiotics
1.8
12
46
2 450
Managing multiple morbidity in mid-life is a common, complex issue
which requires further study to ascertain whether the additional risks are
outweighed by the potential benefits for individual patients. For every
complex prescribing problem there is a simple answer, but it may well be
wrong for any individual person.
References
Townsend A, Hunt K, Wyke S. Managing multiple morbidity in mid-life:
a qualitative study of attitudes to drug use. BMJ 2003;327:837
Evans JMM, McDevitt DG, MacDonald TM. The Tayside Medicines
Monitoring Unit (MEMO): A record-linkage system for pharmacovigilance.
Pharmaceut Med 1995; 9:177-184.
Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more
than 80%. BMJ. 2003; 326: 1419
Competing interests:
None declared
Competing interests: No competing interests