Evidence-based prescription advice is not heeded in a timely fashion
In the largest analysis of its kind, a new study has determined that substantial variation exists in the rate of uptake of newly issued prescribing practices across general practices in the UK.
General practitioners’ rate of implementation of new healthcare practice guidance, based on real-world clinical evidence, is fundamental to the good performance of healthcare practices. In a new study, an international team of researchers from the UK and Canada have analyzed data on the prescribing practices of more than 8000 general practitioners in England, before and after two, evidence-based treatment switches issued over a 5-year period. The results demonstrate that substantial variation exists in the uptake of new prescribing guidance between general practices in the UK, and have important implications for patient care and health expenditure.
The speed of adoption of new, evidence-based healthcare guidance – often referred to as the ‘diffusion of change’ – is a crucial indicator of how well a healthcare system is performing and adapting. Previous research, concerning small sample sizes at single time points, has suggested that ‘diffusion of change’ varies over time.
In this study, to further evaluate the divide between evidence generation and guideline release, and healthcare practice reform, researchers have analyzed data from OpenPrescribing.net and employed automated change detection techniques to determine how rapidly clinicians respond to the release of new treatment guidance.
In the study, researchers focused on data concerning two treatment switches: the first concerned the preferential prescription of the oral contraceptive desogestrel, over Cerazette, in 2012. The second switch, in 2014, concerned the use of nitrofurantoin as the first-line antibiotic choice for uncomplicated urinary tract infection, over trimethoprim.
Researchers observed that 25% of practices did not greatly shift away from prescribing Cerazette for 14 months after the 2012 issuing of the recommendation.
Similarly, 25% of practices did not adopt the preferential prescription of nitrofurantoin for 29 months after the advice was released.
These results demonstrate that significant variation exists between UK practices concerning their timing and rate of adoption of evidence-based healthcare guidance.
In a related editorial, Emma Wallace, from the Royal College of Surgeons (Dublin, Ireland), commented that is essential that clinicians and policy decision makers “…now focus on why this variation is so large, and how open data can help to drive timelier uptake.”
Walker AJ, Pretis F, Powell-Smith A, Goldacre B. Variation in responsiveness to warranted behaviour change among NHS clinicians: novel implementation of change detection methods in longitudinal prescribing data. BMJ; 367(I5205). doi: 10.1136/bmj.l5205. (Epub ahead of print) (2019);
Wallace E. One day or day one? Uptake of new prescribing guidance in general practice. BMJ; 367(I5652). doi: 10.1136/bmj.l5652. (Epud ahead of print) (2019).