High risk of drug side-effects for 60,000
AROUND 60,000 patients in Scotland are prescribed drugs that have a high risk of side- effects, a study shows.
Researchers in Dundee found that many doctors were giving patients treatments which could increase their chances of suffering a reaction due to their age, other health problems or the number of medications they were already taking.
The experts, writing in the British Medical Journal, said in some cases GPs would have good reasons to give high-risk drugs, due to the need to treat illnesses or a lack of other options.
But they said wide differences between practices across Scotland meant there was scope to tackle variations in prescribing patterns and make it safer.
Previous research has shown that so-called "adverse drug events" account for 6.5 per cent of all hospital admissions, over half of which are judged to be preventable.
For the latest study, Professor Bruce Guthrie and colleagues from the University of Dundee's School of Medicine looked at prescribing records from 315 GP practices covering 1.76 million registered patients. They found that 139,404 patients were defined as being "at risk" because of factors such as their age, pre-existing diseases or because they took a number of different drugs on prescription.
Of these, 19,308 were prescribed at least one high-risk drug in the previous year.
This could include instances like the use of antipsychotic drugs in patients with dementia, painkillers like ibuprofen given to people with stomach ulcers or kidney problems, and the prescription of drugs recommended to be avoided in people with heart failure.
The researchers said that high-risk prescribing varied by fourfold between practices, even after they took into account the different types of patients registered with them.
Prof Guthrie said that many high-risk prescriptions were appropriate because doctors and patients were trying to balance the risks and benefits in cases where there was no clearly correct course of action. But he said that the big differences between practices suggested that prescribing could be made safer.
"Our study looked at a sample of about a third of Scottish patients," Prof Guthrie said. "If you take that across the whole of Scotland, then approximately 60,000 people particularly vulnerable to side-effects might be being prescribed high-risk drugs.
"This may be the correct course of action and bring benefits to the patient, but it has to be balanced against the dangers. We're not saying that all this type of prescribing should not be happening, but that we have to be satisfied that it's appropriate and ensure that doing so doesn't put the patient at more risk."
Dr Dean Marshall, chairman of the British Medical Association's Scottish GPs committee, said: "This study fails to discriminate between minor and very serious adverse reactions to drugs. Neither does it recognise the decision-making processes that GPs take when dealing with patients."GPs are aware of the risk of adverse reactions when prescribing and receive a huge amount of information when deciding to prescribe a particular drug."
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