Buccaling under the pressure: influence of secondary care establishments on the prescribing of glyceryl trinitrate buccal tablets in primary care

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Abstract
Objective: To determine which characteristics were the best predictors of high rates of prescribing of glyceryl trinitrate buccal tablets. Design: Practice and patient characteristics from 197 practices were examined, and a multiple regression analysis was performed to examine which variables were important in predicting this prescribing. Setting: Former family health services authority (197 practices). Main outcome measure: Volume of prescribing of glyceryl trinitrate buccal tablets. Results: Four variables contributed significantly to a multiple regression model: the catchment area of the secondary care establishment; the number of partners in a practice; the level of practice deprivation; and whether the practice served an urban or a rural area. The model suggests that the most important variable was the catchment area of the secondary care establishment in which the practice was located. Conclusion: Although only the prescribing of short acting glyceryl trinitrate buccal tablets was studied, an impact of this size on primary care prescribing may have extensive implications for all drug expenditure in primary care. Using glyceryl trinitrate buccal tablets as an example, this study measured the “hospital effect” in different catchment areas in a family health services authority Catchment area was the single most important variable in predicting prescribing levels A statistical model comprising catchment area, urbanity, number of partners in a practice, and a deprivation score explained over 47% of the variation in the prescribing of glyceryl trinitrate buccal tablets