Important steps towards a national drug prescription statistics in Norway

In the first part of this article, drug utilization and prescribing practice is discussed as seen from a Norwegian general practice perspective. Which are the data sources available? What kind of studies have been performed? Prescription-diagnosis studies are reviewed, in particular the Møre & Romsdal Prescription Study (MRPS). Because the wholesales drug statistics do not include information about neither patients, prescribers or diagnoses, there is a current need for establishing a more comprehensive statistics giving wider and deeper insights into the prescribing and utilization of drugs in the Norwegian society. The proposed Norwegian prescription statistics is discussed in relation to previous experiences from prescription-diagnosis studies and current needs for research and statistics in the field. Some examples are given illustrating why the 11-digit person number probably should be included in the database. Lack of diagnostic information may to some extent be compensated for by introducing a more differentiated list of diagnoses for the drugs reimbursed. The use of data from this statistics for quality assurance in e.g. general practice is discussed. Finally, some suggestions are given for how the Norwegian prescription statistics may be organised. STUDYING GPS' PRESCRIBING PRACTICE First we need baseline data "It is hard to evaluate or to improve the quality of something that you do not know how look like. Most physicians know remarkably little about their own practice. Simple things like the distribution of own patients according to gender and age groups, how many patients on treatment for hypertension, or how many who are regular users of benzodiazepines or strong analgesics, remains obscure guesswork." O. Rutle (1995) If we want to do something better (e.g. prescribing), we first need to know what the baseline is. The patterns of prescribing and utilization of drugs are also important because they to some extent reflect what the community needs and wants when it comes to drugs. Descriptive studies serve to profile the present situation and to pinpoint possible problems. Not so many studies have been undertaken to make comprehensive descriptions of drug prescribing practice in general practice. Most studies focus on selected therapeutic areas, specific drugs, or on selected patient groups. Most studies are not limited to general practice, they are rather examining the total drug use as reported by patients in selected populations or districts. With few exceptions, diagnostic information (reason for encounter; diagnosis for prescribing) is generally not available. On the other hand, morbidity statistics from general practice have traditionally been recorded during separate surveys not paying particular attention to the content of prescribing. Data for describing drug utilization or prescribing studies can principally be obtained in two different ways: using routine data that otherwise would have been collected (e.g. for administrative purposes) or the gathering of data within frameworks of specific studies employed to address specific scientific questions. There are both advantages and disadvantages with respect to the kind of data available depending on from where the information is collected. The different data sources for drug utilization studies are listed in Table 1. Table 1. Different sources for drug prescription data. Prescribers (physicians in different settings) Dispensers (pharmacies) Seller of drugs (pharmacies, wholesaler) Payers (owner of institution, reimbursement company) Health authorities (Norwegian Board of Health, County Chief Medical Officer) Other health personnel than the prescriber (e.g. home nurse)