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High-risk prescriptions 'common'

Instances of patients being given high-risk drugs are 'fairly common' in Scotland, according to new research.

Scientists at the University of Dundee said an estimated 60,000 patients are being prescribed drugs with a high risk of side effects.

The study also revealed a big variation between high-risk prescribing at GP practices, with the different approaches to treatment 'largely unexplained'.

The researchers said that although GPs often have good reasons for prescribing high-risk drugs, the preventable side effects from drugs prescribed in primary care are a 'frequent' cause of hospital admissions and even death.

They highlighted instances of anti-psychotic drugs being used for people with dementia and the prescription of anti-inflammatory drugs, such as ibuprofen, to people who have had stomach ulcers or kidney problems.

The team said GPs often prescribe high-risk drugs where there is no obvious 'correct' course of action, but that the big differences between practices suggest that prescribing could be made safer.

Professor Bruce Guthrie and his colleagues at the university medical school's centre for primary care and population research looked at prescribing records and other data from 315 general practices in Scotland with 1.76 million registered patients.

The team found that 139,404 out of 1,760,223 registered patients were defined as being at risk of receiving selected high-risk drugs, due to factors like their age and pre-existing conditions.

Of those at-risk patients, 19,308 had been prescribed at least one high-risk drug in the previous year, researchers said.

They also claimed that rates of high-risk prescribing varied around four-fold between general practices, even after differences in the patients registered with them were taken into account.

Prof Guthrie said: "If you take this across the whole of Scotland, then approximately 60,000 people particularly vulnerable to side effects might be being prescribed high-risk drugs.

"This may be the correct course of action and bring benefits to the patient, but it has to be balanced against the dangers.

"We're not saying that all this type of prescribing should not be happening, but that we have to be satisfied that it's appropriate and ensure that doing so doesn't put the patient at more risk.

"All prescribing is risky to some extent but the drugs we examined are particularly risky in some patients and we have to balance the benefits derived from these drugs with the risks of taking them.

"We identified those people who, due to their age or medical history, are more likely to experience side effects which can be serious.

"What we found was that this type of high-risk prescribing was fairly common but that it varies a lot between practices, and this variation is largely unexplained."

It is now hoped further research can be carried out into the effectiveness of providing uniform prescribing guidelines.

The study is published in the British Medical Journal.

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