Variation in prescription duration for long term conditions: a cohort study in English NHS primary care using OpenPrescribing

Background Many patients receive routine medications for long-term conditions (LTCs). Doctors typically issue repeat prescriptions in one to three month durations, but England currently has no national guidance on the optimal duration.

We calculated the duration of prescriptions for common LTCs in England over a 12-month period (December 2018-November 2019). We assessed the level of variation between regional clinical commissioning groups (CCGs) and determine practice factors associated with different durations.

Of the common medications included, 28-day (one-monthly) prescriptions accounted for 48.5% (2.5 billion) tablets/capsules issued. There was very wide regional variation in the proportion of 28-day prescriptions (7.2% to 95.0%). Practice dispensing status was the most likely predictor of prescription duration. The proportion of patients with LTCs and the electronic health record software used by a practice were also associated with prescription duration.

One month prescription durations are common for patients taking medicines routinely for long term conditions, particularly in dispensing practices. Electronic health record configurations offer an opportunity to implement and evaluate new policies on repeat prescription duration in England. Competing Interest Statement All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare the following BG has received research funding from the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, the NIHR Oxford Biomedical Research Centre, the MohnWestlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organisation, UKRI, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme, he also receives personal income from speaking and writing for lay audiences on the misuse of science. BMK, RC, AB work for the NHS and are seconded to the Bennett Institute. All other University of Oxford authors are employed on BGs grants. Funding Statement This work was supported by The NIHR Biomedical Research Centre, Oxford, A Health Foundation grant (Award Reference Number 7599); A National Institute for Health Research (NIHR) School of Primary Care Research (SPCR) grant (Award Reference Number 327); the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0418-20036) and by the National Institute for Health Research Applied Research Collaboration Oxford and Thames Valley. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS England or the Department of Health and Social Care. Funders had no role in the study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes We have a) made tiny formatting changes so titles and figures appear on same page 2) added some additional funding information to the manuscript Data Availability Data management was performed using Python 3 and Google BigQuery, with analysis carried out using Stata 13.2 / Python 3. Data is openly available from the NHS and all code for data management and analysis are archived online.[16] https://github.com/ebmdatalab/Rx-Quantity-for-Long-Term-Conditions