What can PACT tell us about prescribing in general practice?

Abstract

Objective: To study the extent to which general practitioners' questioning behaviour in routine practice is likely to encourage the adoption of evidence based medicine. Design: Self recording of questions by doctors during consultations immediately followed by semistructured interview. Setting: Urban Australian general practice. Subjects: Random sample of 27 general practitioners followed over a half day of consultations. Main outcome measures: Rate of recording of clinical questions about patients' care which doctors would like answered; frequency with which doctors found answers to their questions. Results: Doctors asked a total of 85 clinical questions, at a rate of 2.4 for every 10 patients seen. They found satisfactory answers to 67 (79%) of these questions. Doctors who worked in small practices (of one or two doctors) had a significantly lower rate of questioning than did those in larger practices (1.6 questions per 10 patients v 3.0 patients, P = 0.049). No other factors were significantly related to rate of questioning. Conclusions: These results do not support the view that doctors routinely generate a large number of unanswered clinical questions. It may be necessary to promote questioning behaviour in routine practice if evidence based medicine and other forms of self directed learning are to be successfully introduced.

Improving Access to Psychological Therapies and antidepressant prescribing rates in England: a longitudinal time-series analysis

“…They only provide a narrow range of information (what drugs are prescribed and their cost), and cannot be linked to demographic or clinical data on patients. 26 Furthermore, they do not provide information about the indications for which the drug was prescribed, and so it was not possible to ascertain what proportion of antidepressants prescribed during the study period were prescribed for depression.…”

Variations in anxiolytic and hypnotic prescribing by GPs: a cross-sectional analysis using data from the UK Quality and Outcomes Framework

“…22 Data were used relating to 'anxiolytics and hypnotics', the term used to describe drugs included in Chapter 4.1 of the British National Formulary (BNF; excluding barbiturates). Similar data were obtained describing the volume of antidepressant and major tranquilliser prescribing (BNF chapters 4.2 and 4.3 respectively).…”

The use of prescribing indicators to measure the quality of care in psychiatric inpatients

“…This is consistent with findings in primary care where prescribing analyses and cost data (PACT) are used to monitor the cost and quality of prescribing. 7 Adherence to quality indicators derived from PACT has been shown to vary widely between practices. 8 Evidence base for these indicators Some research evidence is available which suggests that robust indicators relating to high dose antipsychotic drugs and antipsychotic polypharmacy (indicators 1, 2 and 3) might be of value.…”