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PCGs and Prescribing Audit Presentation at EMIS National User Group Conference Nottingham September 17 th 1999

PCGs and Prescribing Audit Presentation at EMIS National User Group Conference Nottingham September 17 th 1999. DR Amrit Takhar GP, Wansford, Peterborough http://www.wansford.co.uk. Presentation overview. Context Audit Examples of prescribing indicators Tools for analysis .

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PCGs and Prescribing Audit Presentation at EMIS National User Group Conference Nottingham September 17 th 1999

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  1. PCGs and Prescribing AuditPresentation at EMIS National User Group ConferenceNottingham September 17th 1999 DR Amrit Takhar GP, Wansford, Peterborough http://www.wansford.co.uk

  2. Presentation overview • Context • Audit • Examples of prescribing indicators • Tools for analysis

  3. Driving forces • The New NHS • Clinical governance • Performance indicators • Information for Health • Strategic importance of data • National Service Frameworks

  4. Clinical audit identifies opportunities for improvement in patient care and the mechanisms for realising them “Audit has developed in the UK as an educational exercise designed for and by the user to continually improve the standard of health care and sense of professional self esteem”

  5. Audit Cycle • observing current practice • setting standards of care • comparing practice to standards and implementing change

  6. “Clinical indicators should be used to learn, not to judge “ “We learn by making comparisons and trying to understand the sources of variation. 1 Yet too often variation is seenmore as a challenge to authority and competence than as an opportunitytolearn. “ Mulley, BMJ editorial 28 8 99

  7. Prescribing quality indicators Quality knowledge Quality patient care Or…

  8. Indicator types Þdrug choice indicators Þcost indicators Þrange limiting indicators ÞMemphis indicators (or similar) Þother less specific indicators of quality

  9. Prescribing quality indicators - features • Easily measurable and relevant • Be reproducible and reliable • Based on clinical evidence or established practice • Be “owned” and understood by those being assessed

  10. Prescribing quality indicators - features • Independent of demographics • Should be able to set a standard against them and weight them for relative importance • Data providing the indicator should be easy to obtain and manipulate • Responsive and able to be used to monitor trends

  11. Popular indicators ·% Generic - overall rate (262) ·Ratio of inhaled corticosteroids to inhaled bronchodilators (182) ·Prescribing rate of statins for IHD (103) ·Is there a repeat prescribing protocol and is it audited? (79) ·Amitriptyline, dothiepin, imipramine and lofepramine as % of BNF section 4.3 (70)

  12. Ratio of inhaled corticosteroids to inhaled bronchodilators • Easily measurable and relevant to general practice • Be reproducible, relevant and reliable • Based on clinical evidence or established practice • Be “owned” and understood by those being assessed • Independent of demographics • Should be able to set a standard against them and weight them for relative importance • Data providing the indicator should be easy to obtain and manipulate • Responsive and able to be used to monitor trends

  13. Prescribing of statins in IHD • Easily measurable and relevant to general practice • Be reproducible, relevant and reliable • Based on clinical evidence or established practice • Be “owned” and understood by those being assessed • Independent of demographics • Should be able to set a standard against them and weight them for relative importance • Data providing the indicator should be easy to obtain and manipulate • Responsive and able to be used to monitor trends

  14. Generic prescribing as an indicator • Easily measurable and relevant to general practice • Be reproducible, relevant and reliable • Based on clinical evidence or established practice • Be “owned” and understood by those being assessed • Independent of demographics • Should be able to set a standard against them and weight them for relative importance • Data providing the indicator should be easy to obtain and manipulate • Responsive and able to be used to monitor trends

  15. Possible targets • Overall generic rate >70% • Ratio of inhaled corticosteroids to inhaled bronchodilators 1:2 • % patients with a recorded diagnosis of IHD on statins 70%

  16. Evidence based Medicine

  17. Evidence based indicators (McColl et al)

  18. Evidence based indicators Use of ACE inhibitors for patients with heart failure % of population with diagnosis of heart failure % of heart failure patients on ACE inhibitor Use of warfarin for stroke prevention in nonvalvular atrial fibrillation % with NV AF on warfarin prophylaxis

  19. Data collection Standards • Agreed audit standards and interpretation

  20. Data collection to support the measurements of indicators is obviously a big issue and this is likely to be an area where a minimal agreed standard needs to be agreed across a PCG and the infrastructure to achieve this ( eg Appropriate use of IT and training ) It is important to recognise that indicators themselves do not improve quality – this will probably require related activities such as educational initiatives using adult learning principles, spreading best practice and sometimes specific financial support or incentives. Most of the indictors discussed do not have specific agreed standards but it is likely this may come from the newly formed National Institute of Clinical Excellence (NICE). Therefore the interpretation of the indicators will be determined locally by PCGs for the time being

  21. Inherent dangers

  22. Inherent dangers in the choices of performance indicators as clinicians could respond to them in unpredictable ways. The effects of introducing these measures needs proper evaluation to ensure that the changes that occur are positive. Items being measured may be overemphasised at expense of other aspects of care

  23. Tools for analysis • PACT Pact mainly aimed at cost analysis • ePACT • EMIS Source of disease data • Excel Can analyse data from EMIS • Miquest Current best tool to compare • CHDGP Project – best method to improve Data standards in practices

  24. EMIS Search & Statistics A Age/Sex Registers B Patient Searches C Practice Audit D Prescription Statistics

  25. Prescription statistics Collect prescription information Display prescription information List all items between specified dates List all issues of a specified an item between particular dates

  26. Drug costs This function displays individual drug costs Choose:How many drugs do you wish displayed • Display your most expensive drugs or patients • Main advantage over Pact is that you can get data at least 2-3 months before Pact data • Specify time period more flexibly • Before/after intervention • Can highlight most expensive patients – review repeat items

  27. Age/sex distributions Prescribing Enter the BNF group to display (0 for all) For example. Section 2 - Cardiovascular System Drugs. Section 2.1 Cardiac Glycosides :

  28. Lipid lowering agents

  29. “Clinical indicators should be used to learn, not to judge “ Audit – keep ownership Use the appropriate tools DR Amrit Takhar amrit@btinternet.com GP, Wansford, Peterborough • http://www.wansford.co.uk

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