Is use of homeopathy associated with poor prescribing in English primary care? A cross-sectional study. (May 2018)

• Record Type: Journal Article
• Authors: Walker, Alex J; Croker, Richard; Bacon, Seb; Ernst, Edzard; Curtis, Helen J; Goldacre, Ben
• Is Part Of: Journal of the Royal Society of Medicine. Volume 111:Number 5(2018)
• Page Start: 167
• Page End: 174
• Publication Date: 2018-05
• Subjects: Homeopathy -- prescribing -- OpenPrescribing; Medicine -- Periodicals; Medicine -- Great Britain -- Periodicals; Periodicals; 610.5
• DOI: 10.1177/0141076818765779
• Languages: English
• ISSNs: 0410-0768

Abstract

Objectives: Prescribing of homeopathy still occurs in a small minority of English general practices. We hypothesised that practices that prescribe any homeopathic preparations might differ in their prescribing of other drugs. Design: Cross-sectional analysis. Setting: English primary care. Participants: English general practices. Main outcome measures: We identified practices that made any homeopathy prescriptions over six months of data. We measured associations with four prescribing and two practice quality indicators using multivariable logistic regression. Results: Only 8.5% of practices (644) prescribed homeopathy between December 2016 and May 2017. Practices in the worst-scoring quartile for a composite measure of prescribing quality (>51.4 mean percentile) were 2.1 times more likely to prescribe homeopathy than those in the best category (<40.3) (95% confidence interval: 1.6–2.8). Aggregate savings from the subset of these measures where a cost saving could be calculated were also strongly associated (highest vs. lowest quartile multivariable odds ratio: 2.9, confidence interval: 2.1–4.1). Of practices spending the most on medicines identified as 'low value' by NHS England, 12.8% prescribed homeopathy, compared to 3.9% for lowest spenders (multivariable odds ratio: 2.6, confidence interval: 1.9–3.6). Of practices in the worst category for aggregated price-per-unit cost savings, 12.7% prescribed homeopathy, compared to 3.5% in the best category (multivariable odds ratio: 2.7, confidence interval: 1.9–3.9). Practice quality outcomes framework scores and patient recommendation rates were not associated with prescribing homeopathy (odds ratio range: 0.9–1.2). Conclusions: Even infrequent homeopathy prescribing is strongly associated with poor performance on a range of prescribing quality measures, but not with overall patient recommendation or quality outcomes framework score. The association is unlikely to be a direct causal relationship, but may reflect underlying practice features, such as the extent of respect for evidence-based practice, or poorer stewardship of the prescribing budget.