General practices’ prescribing performance gap over time
In 2009, the proportion of moderate to high stroke risk patients (CHA2DS2-VASc≥1 and male or CHA2DS2-VASc≥2 and female) with AF and an OAC prescription recorded among the lowest prescribing practice quintile was 24.7% (95% CI 22.3%-27.4%), compared with 54.7% (95% CI 52.6%-56.9%) in the highest quintile. By 2018, prescribing had increased to 38.6% (95% CI 37.2%-40.1%) and 65.6% (95% CI 64.5%-66.7%) in the lowest and highest practice quintiles, respectively. The gap between the highest- and lowest-prescribing practice quintiles in OAC prescribing for patients with moderate to high stroke risk remained wide, falling slightly from 30.0% in 2009 to 25.9% in 2018 (Figure 2).
A total of 429 practice sites contributed data in 2018. Of these, 169 (39.4%) had provided data since 2009, of which 64 (37.9%) of practice sites’ OAC prescribing quintile did not change, and 120 (71.0%) practice sites continued in the same or closest prescribing quintile. There was a fair agreement in practices sites’ prescribing quintile between 2009 and 2018, weighted kappa=0.34 (95% CI 0.24-0.45) (McHugh, 2012).
In 2009, the proportion of patients with AF who were prescribed an OAC while potentially not recommended (CHA2DS2-VASc=0 and male or CHA2DS2-VASc=1 and female) in the lowest- and highest-prescribing quintiles were 5.7% (95% CI 3.7%-8.4%) and 39.3% (95% CI 31.3%-47.8%), respectively. At the end of the study period, the proportion of potentially inappropriate prescribing in the lowest- and highest-prescribing quintiles increased to 6.7% (95% CI 5.5%-8.0%) and 47.1% (95% CI 41.9%-52.4%), respectively (Figure 2).