Who controls repeats?

BACKGROUND: The need for patients on long-term medication to be periodically reviewed is well documented, but until now there have been no large-scale systematic studies of the process of repeat prescribing. AIM: To propose a model for the process and control of repeat prescribing in general practice, and to use this model to evaluate the management control and clinical control of repeat prescribing in 50 practices.
METHOD: Interviews were conducted with practice staff and the process of repeat prescribing was observed in consenting practices from 57 randomly selected practices in Leeds. A batch of repeat prescriptions was identified in each practice, and the patients' records were examined for evidence of clinical authorization and review. The records of 427 patients taking 556 drugs within three drug groups were studied. A subjective scoring system was used to assess quality of management control. Clinical control was assessed by noting the presence or absence of evidence in general practitioner records of doctor authorization of repeat status, and of clinical review of therapy for each drug.
RESULTS: Management control-Many practices had inadequate controls of repeat prescribing, leading to unauthorized repeat prescriptions, poor compliance checks (or none at all), and inadequate systems, if any, for identifying patients in need of medication review, and for bringing them to prescribers' attention. Clinical control-66% of repeat drugs showed no evidence of authorization by a doctor; 72% showed no evidence of having been reviewed by a doctor in the previous 15 months.
CONCLUSION: Inadequate control of repeat prescribing is wasteful and potentially dangerous. Major improvement is required in the management and clinical aspects of the control of repeat prescribing in many practices. This will need changes in procedures and training, and may require more resources and the imaginative use of nurses and pharmacists.