Download PCGs and Prescribing Audit

PCGs and Prescribing Audit
Presentation at
EMIS National User Group Conference
Nottingham September 17th 1999
DR Amrit Takhar
GP, Wansford, Peterborough
http://www.wansford.co.uk
Presentation overview
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Context
Audit
Examples of prescribing indicators
Tools for analysis
Driving forces
The New NHS
Clinical governance
Performance indicators
Information for Health
Strategic importance of data
National Service Frameworks
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”
observing current
practice
setting standards of
care
comparing practice to
standards and
implementing change
“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 seen more as a
challenge to authority and competence than
as an opportunity to learn. “
Mulley, BMJ editorial 28 8 99
Quality knowledge
Quality patient
care
Or…
Indicator types
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drug choice indicators
cost indicators
range limiting indicators
Memphis indicators (or similar)
other less specific indicators of
quality
Prescribing quality indicators - features
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Easily measurable and relevant
Be reproducible and reliable
Based on clinical evidence or
established practice
Be “owned” and understood by those
being assessed
Prescribing quality indicators - features
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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
Popular indicators
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% Generic - overall rate (262)
Ratio of inhaled corticosteroids to inhaled
bronchodilators (182)
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Prescribing rate of statins for IHD (103)
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Is there a repeat prescribing protocol and
is it audited? (79)
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Amitriptyline, dothiepin, imipramine and
lofepramine as % of BNF section 4.3 (70)
Ratio of inhaled corticosteroids to inhaled
bronchodilators
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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
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Independent of demographics
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Should be able to set a standard against them and
weight them for relative importance
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Data providing the indicator should be
easy to obtain and manipulate
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Responsive and able to be used to monitor trends
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?
Prescribing of statins in IHD
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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
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Independent of demographics
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Should be able to set a standard against them and weight them for relative
importance
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Data providing the indicator should
be easy to obtain and manipulate
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Responsive and able to be used to monitor trends
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?
Generic prescribing as an indicator
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Easily measurable and relevant to general practice
Be reproducible, relevant and reliable
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Based on clinical evidence or
established practice
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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
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Possible targets
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Overall generic rate >70%
Ratio of inhaled corticosteroids to
inhaled bronchodilators 1:2
% patients with a recorded diagnosis of
IHD on statins 70%
Evidence based indicators
(McColl et al)
Use of aspirin for
% of patients with
patients at high risk of IHD taking aspirin
coronary or ischaemic
cerebrovascular events
Flu vaccination in
the over 65’s
% of over 65s
vaccinated
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
Data collection Standards
 Agreed audit standards and
interpretation
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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
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
Tools for analysis
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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
EMIS Search & Statistics
A Age/Sex Registers
B Patient Searches
C Practice Audit
D Prescription Statistics
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
Drug costs
This function displays individual drug costs
Choose:How
many drugs do you wish
displayed
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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
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
:
% of patients on lipid low ering rx
10%
9%
8%
7%
6%
5%
4%
3%
2%
1%
0%
35-44
45-54
55-64
65-74
75-84
85-89
90+
“Clinical indicators should be
used to learn, not to judge “
Audit – keep ownership
Use the appropriate tools
DR Amrit Takhar [email protected]
GP, Wansford, Peterborough
•
http://www.wansford.co.uk