pcgs and prescribing audit presentation at emis national user group conference nottingham september...
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PCGs and Prescribing AuditPresentation at
EMIS National User Group ConferenceNottingham September 17th 1999
DR Amrit Takhar
GP, Wansford, Peterboroughhttp://www.wansford.co.uk
Presentation overview 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 drug choice indicators
cost indicators
range limiting indicators
Memphis indicators (or similar)
other less specific indicators of quality
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
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
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)
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
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
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
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%
Evidence based indicators (McColl et al)
Use of aspirin for patients at high risk of coronary or ischaemic cerebrovascular events
% of patients with IHD taking aspirin
Flu vaccination in the over 65’s
% of over 65s vaccinated
Evidence based indicatorsUse 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
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 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 & StatisticsA Age/Sex Registers
B Patient Searches
C Practice Audit
D Prescription Statistics
Prescription statisticsCollect prescription information
Display prescription informationList all items between specified dates
List all issues of a specified an item between particular dates
Drug costsThis 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
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
:
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
35-44 45-54 55-64 65-74 75-84 85-89 90+
% of patients on lipid lowering rx
Series3
Series4
“Clinical indicators should be used to learn, not to judge “
Audit – keep ownership
Use the appropriate toolsDR Amrit Takhar [email protected]
GP, Wansford, Peterborough• http://www.wansford.co.uk