Survey of anti-obesity drug prescribing for obese children and young people in UK primary care.
Author(s)
Type
Journal Article
Abstract
Objectives Antiobesity drug (AOD) prescribing in children
and young people (CYP) in primary care is rising with high
rates of discontinuation. Little is known about prescribing
in this group in terms of patient demographics and
comorbidities, reasons for initiation and discontinuation, or
adherence to national guidelines.
Design Questionnaire survey to general practitioners
(GPs) identified using a nationally representative primary
care database covering 6% of UK population.
Setting UK-wide primary care.
Participants Patients were eligible if prescribed an
AOD aged ≤18 years between 2010 and 2012. A total of
151 patients from 108 unique practices were identified
via national prescribing database, with responses for 119
patients (79%) from 84 practices; 94 of 119 (79%) were
eligible for inclusion.
Primary and secondary outcomes Survey of GP
prescribing habits of AODs to CYP. We audited orlistat
usage against the National Institute for Health and Care
Excellence (NICE) guidance.
Results 47% were prescribed metformin, 59% orlistat
and 5% both drugs. Orlistat was largely prescribed by GPs
independently (49/55 prescriptions, 89%) and metformin
by GPs on specialist recommendation (12/44, 27%).
Orlistat was largely prescribed in those over 16 years
of age without physical comorbidities. Metformin was
initiated for treatment of polycystic ovarian syndrome
(70%), insulin resistance (25%) and impaired glucose
control (9%). Median supply of metformin was 10.5
months (IQR 4–18.5 months) and 2.0 months (1.0–4.0) for
orlistat (p≤0.001). Drug terminations were largely due to
families not requesting repeat prescriptions. NICE guidance
adherence was low; 17% of orlistat prescriptions were
initiated by specialists, and 56% had evidence of obesityrelated
comorbidity. GPs reported lower confidence in
prescribing AOD to CYP compared with adults (10-point
Likert score median 3 vs 8, p<0.001).
Conclusions Prescribing of AOD in primary care is
challenging with low adherence to NICE guidance. Further
work is needed to better support GPs in the use of AOD in
CYP.
and young people (CYP) in primary care is rising with high
rates of discontinuation. Little is known about prescribing
in this group in terms of patient demographics and
comorbidities, reasons for initiation and discontinuation, or
adherence to national guidelines.
Design Questionnaire survey to general practitioners
(GPs) identified using a nationally representative primary
care database covering 6% of UK population.
Setting UK-wide primary care.
Participants Patients were eligible if prescribed an
AOD aged ≤18 years between 2010 and 2012. A total of
151 patients from 108 unique practices were identified
via national prescribing database, with responses for 119
patients (79%) from 84 practices; 94 of 119 (79%) were
eligible for inclusion.
Primary and secondary outcomes Survey of GP
prescribing habits of AODs to CYP. We audited orlistat
usage against the National Institute for Health and Care
Excellence (NICE) guidance.
Results 47% were prescribed metformin, 59% orlistat
and 5% both drugs. Orlistat was largely prescribed by GPs
independently (49/55 prescriptions, 89%) and metformin
by GPs on specialist recommendation (12/44, 27%).
Orlistat was largely prescribed in those over 16 years
of age without physical comorbidities. Metformin was
initiated for treatment of polycystic ovarian syndrome
(70%), insulin resistance (25%) and impaired glucose
control (9%). Median supply of metformin was 10.5
months (IQR 4–18.5 months) and 2.0 months (1.0–4.0) for
orlistat (p≤0.001). Drug terminations were largely due to
families not requesting repeat prescriptions. NICE guidance
adherence was low; 17% of orlistat prescriptions were
initiated by specialists, and 56% had evidence of obesityrelated
comorbidity. GPs reported lower confidence in
prescribing AOD to CYP compared with adults (10-point
Likert score median 3 vs 8, p<0.001).
Conclusions Prescribing of AOD in primary care is
challenging with low adherence to NICE guidance. Further
work is needed to better support GPs in the use of AOD in
CYP.
Date Issued
2017-10-25
Date Acceptance
2017-10-02
Citation
BMJ Paediatrics Open, 2017, 1
ISSN
2399-9772
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Paediatrics Open
Volume
1
Copyright Statement
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
License URL
Sponsor
NIHR
National Institute for Health Research
Grant Number
PD-SPH-2015-10055
Article Number
e000104