Introduction

The NHS uses the Jarman underprivileged area (UPA) score to weight capitation payments to General Practitioners (GPs). The score takes into account geographic variations in the demand for Primary Care based medical services. This study reviewed rates of GP prescribing of non-prescription drugs (those which can otherwise be purchased in pharmacies) in Northern Ireland (NI). Prescribing trends for both rural and urban populations within one of the four Health and Social Services Boards (HSSB) were investigated. The relationship between non-prescription medicine prescribing and Jarman UPA scores for the geographical area was examined.

Method

The study employed techniques developed to interrogate the NI prescribing database¹. The Geographical Information System, 'GIS-Map Info' was used to produce a thematic map of total ward populations in the Southern HSSB with a default setting of five population bandings. GP Practices were then grouped according to the population size of the electoral ward in which they were sited. GP Practices sited in areas with a population of 1,470 to 2,430 (n=17) were determined to be rural and those located in wards with populations of 2,430 to 4,600 (n=56) were considered to be urban. The number of non-prescription items, expressed as a percentage of the total number of prescribed items was recorded for each GP practice. This prescribing trend was then compared with the percentage of patients per practice with a Jarman underprivileged area (UPA) score of greater than 20. An area with a higher score is more deprived than one with a lower score.

Results

A population profile based on Jarman UPA score bands was categorised as follows:

Jarman UPA Score 20-29, (6.5%); 30-39, (2%); 30-39, (0.2%). A significantly positive correlation was observed between rates of non-prescription prescribing and increased Jarman scores for practices based in higher population densities (Pearson correlation coefficient r=0.47; p<0.0005). There was no significant correlation observed at lower population densities (Pearson correlation coefficient r=0.12; p=0.65).

Discussion

It has been established that the GP prescribing rates for non-prescription drugs are significant¹ and may be related to patients' ability to afford the cost of such medicines. A relationship is observed between such prescribing and an indicator used to predict deprivation. The study supports the view that the Jarman index is considered to be better suited to inner city areas, rather than to rural areas². The Jarman score takes eight weighted variables into account including unemployment, overcrowding and children under 5 years. There is a need for further comparison of NI prescribing trends with locally developed measures of deprivation.

References.

1. Timoney M.G., Hughes C.M. and McElnay J.C. (2002) The use of a prescribing database to assess the extent of general practice prescribing of non-prescription medications. Presented at the 8^th Health Services Research and Pharmacy Practice Conference, Leeds, 2002.

2. Talbot R.J. (1991) Underprivileged areas and health care planning implications of use of Jarman indicators of urban deprivation. BMJ 302:383-6.