Senior Lecturer School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences Dublin, Ireland
Background: A substantial proportion of medicines use is considered to be potentially inappropriate or represent low-value care. In 2017, two distinct interventions were implemented in Ireland and England to reduce prescribing of lidocaine medicated plasters. In Ireland, the process for reimbursement was changed, with the introduction of an online reimbursement applications system. In England, updated guidance on items which should not routinely be prescribed in primary care, including lidocaine plasters, was published.
Objectives: This study aims to compare how the interventions impacted prescribing of lidocaine plasters in the two countries.
Methods: We conducted an interrupted time series study using segmented regression analysis to assess the change in prescribing rate following the introduction of guidance and policy changes. For Ireland, dispensing data related to the means-tested General Medical Services (GMS) scheme was used. For England, prescription data for all GP practices was used. Monthly data at the level of the Local Health Office/Clinical Commissioning Group for 2015-2019 was analysed. Outcomes were the rate of dispensings, quantity and costs of lidocaine plasters, and we modelled the level and trend change from the first full month of the policy/guidance change.
Results: In Ireland, there was a reduction in the dispensing of lidocaine plasters of 15.14 (95%CI 14.76 to 15.53) per 1,000 GMS eligible population following the introduction of the two-step reimbursement change, equivalent to a 97.3 percent reduction in the dispensing rate immediately pre-intervention. In England, an immediate reduction of 0.0251 (95%CI 0.036 to 0.0142) dispensings per 1,000 population (a 5.8 percent decrease), followed by a small but significant decrease in the monthly trend relative to the preintervention trend of 0.0057 per month (95%CI 0.0064 to 0.0051).
Conclusions: Our study has shown the effects of two different interventions aiming to decrease low-value prescribing of lidocaine plasters, and the substantially larger impact of a change to reimbursement compared to issuing guidance. However, this is in the context of a much higher baseline rate of use in Ireland compared to England.
.jpg "Frank Moriarty, MPharm PhD MPSI (he/him/his) photo")
