Prescribing patterns for medical treatment of suspected prostatic obstruction: A spatiotemporal statistical analysis of Scottish open access data

Background Healthcare services treating men with prostate conditions are increasingly burdened worldwide. One of the competing factors in this demand is increasing diagnosis and treatment of lower urinary tract symptoms in men, much of which is suspected bladder outflow obstruction secondary to benign prostate hyperplasia/enlargement. However, the impact of increases on services is largely hidden, and there is limited knowledge of potential differences in management based on geography. Objective To investigate potential variation in the prescribing of drugs for suspected bladder outflow obstruction in Scotland based on analysis of publicly available data, and identify trends that may help to inform future prescribing behaviour. Design, setting, and participants We linked the relevant publicly available prescribing and patient data to all general practices in Scotland between October 2015 and November 2019. Outcome measurements and statistical analysis We analysed the numbers of daily doses of drugs prescribed for suspected bladder outflow obstruction per month using a Bayesian Poisson regression analysis, incorporating random effects to account for spatial and temporal elements in prescribing. Results Prescriptions of drugs to treat suspected bladder outflow obstruction increased during the observation period in Scotland, consistent with an ageing population and increased diagnosis. Whilst some determinants of health inequality regarding prescribing practices across health boards are consistent with those known from the literature, other inequalities remain unexplained after accounting for practice- and patient-specific characteristics such as socio-economic deprivation and rurality. Conclusions Variations in spatiotemporal prescribing for suspected bladder outflow obstruction exist in Scotland, some of which are unexplained and require further investigation.