Emollient prescribing formularies in England and Wales: a cross-sectional study

OBJECTIVE: To identify and compare emollient formularies across all clinical commissioning groups (CCGs) and local health boards (LHBs) in England and Wales. DESIGN: Formularies were retrieved via CCG/LHB websites or Google search (October 2016–February 2017). Data on structure and content were extracted, and descriptive analyses were undertaken. SETTING: 209 English CCGs and 7 Welsh LHBs. MAIN OUTCOME MEASURES: Number and structure of formularies; number, type and name of emollients and bath additive recommendedandnot recommended; and any rationale given. RESULTS: 102formularies were identified, which named 109 emollients and 24 bath additives. Most were structured in an ‘order of preference’ (63%) and/or formulation (51%) format. Creams and ointments were the most commonly recommended types of emollients, and three ointments were the most commonly recommended specific emollients (71%–79% of formularies). However, there was poor consensus over which emollient should be used first line and 4 out of 10 of the most recommended lotions and creams contained antimicrobials or urea. Patient preference (60%) and/or cost (58%) were the most common reasons given for the recommendations. Of the 82% of formularies that recommend the use of bath additives, 75% did not give any reasons for their recommendation. CONCLUSIONS: Emollient formularies in England and Wales vary widely in their structure, recommendations and rationale. The reasons for such inconsistencies are unclear, risk confusion and make for inequitable regional variation. There is poor justification for multiple different, conflicting formularies.