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Title: The influence of socioeconomic deprivation on prescribing within primary care
Author: Timoney, Mark Gerald
ISNI:       0000 0001 3533 6039
Awarding Body: Queen's University Belfast
Current Institution: Queen's University Belfast
Date of Award: 2008
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Gradients in area-level socioeconomic deprivation have been associated with variations in the delivery of healthcare services and outcomes across geographical areas. This thesis assesses the impact of deprivation on prescribing rates for non-prescription medicines and prescription medicines indica. ted for the management ... of conditions affected by socioeconomic variables including cardiovascular disease and diabetes. Th~ research also examined the influence ofthe Quality and Outcomes Framework (QOF) in minimisfng . prescribing variations and outcomes in cardiovascular disease. Northern Ireland demographic, mapping, prescribing and area-level deprivation data were collected retrospectively from 2000 to 2005. The first stage ofthe investigation revealed that the levels of General Practitioner prescribing for non-prescription medicines were high (30%). These prescribing rates increased as proportions of practice populations living in areas of highest deprivation increased, particularly in urban locations, and were closely correlated to income and employment deprivation. Measures of deprivation developed for application in NI appeared to be better at predicting these variations in rural areas than other extant indices of deprivation. Prescribing rates for codeine-containing and non-steroidal anti-inflammatory drugs (NSAIDs) analgesics together with benzodiazepines and, most notably, antidepressants were positively associated with increased proportions of patients living in areas associated with highest levels of deprivation. Inconclusive findings in relation to trends in Hormone Replacement Therapy (HRT) and methylphenidate prescribing may have been accounted for by lower observed rates of prescribing volume. The final study observed cardiovascular and diabetes prescribing trends and demonstrated annual increases in growth of prescribed items which appeared to respond to the implementation ofthe QOF. A time series analysis, employing a refined methodology, confirmed that significant increases in statin doses were observed after the second quarter of2004 immediately post-QOF and that the increase responded positively to rising levels of practice deprivation. However, no impact on the reduction of Coronary Heart Disease admissions to hospital was observed over the course of this investigation. Overall the research has tested the consistent influence of deprivation on prescribing trends and has identified how the employment of area-based deprivation measures may be used to target prescribing resources. Policy and planning arrangements should take into account the impact of multiple deprivation in driving demand for healthcare services and associated prescribing resources. Healthcare strategies should consider how these demands can be equitably managed and met. Pharma.ceutical public health and medicines management interventions should be evaluated and commissioned.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available