• Br J Gen Pract · Feb 2004

    An evaluation of the impact of NICE guidance on GP prescribing.

    • Bernard Wathen and Tara Dean.
    • North Devon District Hospital, Raleigh Park, Barnstaple, North Devon EX31 4JB, UK. bernie.wathen@ndevon.swest.nhs.uk
    • Br J Gen Pract. 2004 Feb 1; 54 (499): 103107103-7.

    BackgroundOne of the aims of the National Institute for Clinical Excellence (NICE) is to promote faster access to the best treatments. However, there is no published research on the impact that NICE guidance has had on prescribing decisions.AimsTo explore the attitudes of general practitioners (GPs) to NICE guidance and to investigate any changes in prescribing patterns.DesignDescriptive cross-sectional study.SettingNorth Devon Primary Care Trust.MethodFive technology appraisals most likely to impact on GP prescribing were investigated. Prescribing analysis and cost (PACT) data were analysed for changes in prescribing patterns before and after the publication of each technology appraisal. A postal questionnaire, developed from semi-structured interviews, was sent to all GPs within a single primary care trust (PCT) to explore factors that were encouraging or discouraging adherence to NICE guidance.ResultsPACT data showed that there was an increase in the prescribing of the drugs studied immediately after NICE guidance, with the exception of zanamivir (Relenza [GlaxoSmithKline]); only one zanamivir inhaler was prescribed during the study period. Although there was an increase in the prescribing of maintenance doses of proton pump inhibitors, there was also an increase in treatment doses. Eighty-one (82.7%) questionnaires were completed and returned. In general, there was a balance between the factors that encouraged and those that discouraged adherence. The main exception was zanamivir, where factors that discouraged adherence greatly exceeded factors that encouraged adherence.ConclusionsThis study showed that NICE guidance in isolation had little impact on GP prescribing. Where the guidance coincided with information from other sources, or personal experience, there was some evidence that technology appraisals triggered an increase in prescribing, but that this was not always sustained. The recommendations of NICE concerning zanamivir were universally rejected and there was evidence that this had undermined confidence in NICE recommendations in general.

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