Analysis of paediatric prescribing profiles in two health-funding systems

Objective. To investigate the adequacy of two large South African medical administrative databases in providing prescribing profiles for paediatricians and general practitioners (GPs) respectively. Design. Statistical analysis of data captured during 1994. Data were analysed retrospectively with frequency analysis and non-parametric tests. Setting. Two industry databases, one covering a prepaid health maintenance organisation (HMO), the other providing a chronic medication programme for medical schemes and their members. Main outcome measures. Comparison of prescribing profiles of specialists and GPs. Main results. Data from the HMO revealed that referrals to paediatricians were mainly for gastro-intestinal and respiratory problems. Paediatricians' prescriptions for treatment of gastro-oesophageal reflux and/or abdominal pain represented 15.5% of all items prescribed and accounted for 40.7% of total paediatric medicine costs. GPs used formulary items more frequently, and cost per prescription was two-thirds that of specialists. Data from the chronic medication programme were used to compare treatment of asthma by the two provider groups. There were significant differences in the prescribing profiles of the two groups, with specialists using more in the way of 'third-line agents' and newer, expensive products. Significant numbers of prescriptions did not conform to national guidelines for treatment of asthma. Conclusions. Industry databases provide a viable and valuable source of information; however, some problems were experienced in extracting the required data. Prescribing profiles revealed certain practices that require review, in particular the relatively low use of generic products, the early resorting to drug therapy for gastrooesophageal reflux, and non-conformity with national guidelines for management of childhood asthma.