Last year, the King's Fund identified improved medicines management as one of 10 high-impact issues in achieving better patient outcomes and efficient use of resources.1
Its report noted that prescribing costs ‘are rising at a relentless rate – about 7% in real terms – and account for 12% of the NHS budget'. Around 7% of hospital admissions have been attributed to adverse drug reactions and evidence shows up to two-thirds were preventable.2
Below are tips for using data to help improve the quality and efficiency of prescribing for member practices of your CCG.
1 Start with good data
In general, employing an analyst full time at central support-services level is the most cost-effective way of getting good data although some larger CCGs might employ an analyst directly. Variation in prescribing or the use of an expensive drug sometimes is sometimes justified. For example, prescribing costs in a practice serving a high number of care homes are obviously going to be higher than those for a practice with a high proportion of students.
2 Agree reasonable performance measures
When benchmarking, consider both comparisons with regional and national data. The NHS Business Services Authority publishes monthly prescription statistics that can be accessed by PCTs, CCGs and individual practices.
National comparator data is also available on the QIPP section of the National Prescribing Centre website.
Software prescribing support systems
such as Scriptswitch and Eclipse can be tailored to support specific care pathways or the prescribing priorities of a CCG.
3 Look for both over- and under-prescribing
NSAIDS are a good example here, as there is a threefold variation in NSAID prescribing rates between PCTs in England. Are outliers in the high use of NSAIDS – particularly diclofenac and COX2 inhibitors when alternatives are preferable – also found in other prescribing areas?
When looking for instances of under-prescribing, start by comparing prevalence and prescribing to find practices with poor levels of diagnosis in particular disease
areas.
4 Include medicines optimisation in all pathway redesign
A simple example of this would be that, when moving a dermatology service from secondary care to the community, your CCG implements safeguards to ensure community-based health professionals such as pharmacists are aware of the MHRA guidance around women prescribed isotretinoin.
The use of high-cost new drugs in primary care might lead to reduced hospital admissions – for example, if newer anticoagulants prove more clinically effective than older ones.
5 Commission community pharmacy services to optimise medicine use
Build on services provided through the national community contractual framework, such as the New Medicines Service and MURs. Support patients who are starting on new medication – one study has shown that 10 days after starting medication, two-thirds of patients were having medicine-related problems and one-third had stopped using the medication.4
6 Look for educational opportunities and professional development sessions to change habits
Getting pharmaceutical evidence into practice can be difficult. For instance, many doctors regarded ß-blockers as contraindicated for heart failure treatment – rather than a treatment – several years after evidence to the contrary was widely accepted. Likewise, some doctors are still using diclofenac when there is evidence that alternatives are safer for patients. Data on prescribing errors could provide the focus for a local education campaign.
Kym Lowder is a pharmacist in Kent and a Primary Care Commissioning associate
References
1 King's Fund. Transforming our health care system – 10 priorities for commissioners. 2011.
2 Pirmohamed M et. al. Adverse drug reactions as cause of admission to hospital: Prospective analysis of 18820 patients. BMJ 2004;329;15-9.
3 National Collaborating Centre for Primary Care and RCGP. Clinical guidance and evidence review for medicines adherence: involving patients in decisions about prescribing and supporting adherence. 2009.
4 King's Fund. The quality of GP prescribing. 2011.
