NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Prescribing Initiatives and Indicators

Health and Social Care Partnership Prescribing Initiatives and Indicators

Details of the 2018-19 prescribing initiative have been sent to GP practices.  To date 89% of GP practices (210/235) have committed to undertake the following six actions.

This year’s initiative focuses on:

1. Prescribing of DOACs and consideration of edoxaban (for prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (NVAF) with one or more risk factors)
2. Prescribing of blood glucose and ketones test strips and consideration of GlucoRx Nexus®, Glucomen Areo®, Glucomen Areo 2K® and CareSens Dual®
3. Prescribing of dipeptidylpeptidase-4 inhibitors and consideration of alogliptin
4. Prescribing of combination inhaled devices and consideration of Fostair®/Relvar® or Trelegy®/Trimbow®
5. Prescribing of lidocaine plasters and consideration of continuation (or switch to Ralvo®)
6. Prescribing of long-term opioids and consideration of continuation

In addition to these six actions, the National Therapeutic Indicators for GP practice prescribing have been developed by a national reference group drawn from the Scottish Pharmacy Practice and Prescribing Advisers Association (SP3AA) with other relevant groups (e.g. Accountable Officers, Scottish Patient Safety Programme).  These are available to GP practices to use in any quality improvement initiatives they might be undertaking.  They can also be used by practices to review their prescribing patterns. A national report providing the health board figures will be published shortly along with reports in the NHS NSS Business Objects platform for anyone with access to PRISMS/PIS to run themself.  Please contact prescribing@ggc.scot.nhs.uk if you have any questions.

(If viewing table on a mobile device switch to landscape)

Indicator Group Drug group/adverse effect Indicator Description
CNS - analgesic Analgesics (gabapentanoids) Gabapentanoids: pregabalin and gabapentin DDDs per 1,000 LS per day*
CNS - analgesic Analgesics (opioids) Opioid analgesics: strong opioids (including tramadol preparations) DDDs per 1,000 LS per day*
CNS - analgesic Topical Anaesthetic Lidocaine: lidocaine plasters GIC per 1,000 LS*
CNS - psychotropic Hypnotics and Anxiolytics Hypnotics and Anxiolytics: hypnotics and anxiolytics DDDs per 1,000 LS per day*
Endocrine Antidiabetic drugs Antidiabetic Drugs: number of people prescribed metformin as percentage of all people prescribed an antidiabetic drug
Endocrine SMBG SMBG: average cost per day of blood glucose test strips per person prescribed antidiabetic drugs and/or insulins
Gastrointestinal Proton Pump Inhibitors Proton Pump Inhibitors: proton pump inhibitors DDDs per 1,000 LS per day*
Infection Antibiotics Antibiotics: total antibiotic script items per 1,000 LS per day
Infection Antibiotics (4C) Antibiotics: 4C antibiotics script items per 1,000 LS per 100 days
MHRA warning Developmental disability or birth defects Valproate: females aged 13 to up to 45 prescribed valproate as a % of all females dispensed valproate
Musculoskeletal NSAIDs NSAIDs including Cox-2 inhibitors: NSAIDs (including COX-2 inhibitors) DDDs per 1,000 LS per day*
Polypharmacy Acute Kidney Injury Acute Kidney Injury: number of people aged  ≥65 years co-prescribed a NSAID and an ACE inhibitor/angiotensin receptor blocker and a diuretic as a percentage of all people aged  ≥65 years prescribed an ACE inhibitor/angiotensin receptor blocker and a diuretic
Polypharmacy Antibiotics (repeated courses) Antibiotics: number of people prescribed > 4  prescriptions for antibiotics per annum as a percentage of all people prescribed antibiotics
Polypharmacy Antibiotics (UTI) Antibiotics: number of  3-day course of acute UTI antibiotics prescribed to women as a percentage of all acute UTI antibiotic courses prescribed to women
Polypharmacy Antidiabetic Drugs Polypharmacy in Diabetes: number of people prescribed three or more categories of diabetes medication  as a percentage of all people prescribed an anti-diabetic drug
Polypharmacy Antipsychotics Antipsychotics: number of people aged ≥75 years prescribed an antipsychotic as a percentage of all people aged ≥75 years
Polypharmacy Bone Marrow Suppression Bone Marrow Suppression: number of people prescribed methotrexate without co-prescription of folic acid as a percentage of all people prescribed methotrexate
Polypharmacy Falls, Fractures and Delirium  Falls, Fractures and Delirium: number of people aged ≥75 years dispensed > 10 items of strong or very strong anticholinergics (mARS 2&3) per annum as a percentage of all people aged ≥75 years 
Polypharmacy Falls, Fractures and Delirium Sulfonylureas: number of people aged ≥ 75 years prescribed sulfonylureas as a percentage of all people aged ≥ 75 years prescribed an anti-diabetic drug
Polypharmacy Falls, Fractures and Delirium Falls, Fractures and Delirium: number of people prescribed a long term oral steroid without co-prescription of a bone protecting agent as a percentage of all people prescribed a long term oral steroid 
Polypharmacy High Strength Inhaled Corticosteroids High Dose Corticosteroid Inhalers: high dose corticosteroid inhalers as a percentage of all corticosteroid inhalers (items) using 2016 SIGN/BTS classification
Polypharmacy Opioid and gabapentinoid dependency Gabapentinoid dependency: number of people prescribed a gabapentanoid at an average daily dose equivalent to >4800mg gabapentin over the previous 6 months as a percentage of all people prescribed a gabapentanoid
Polypharmacy Opioid and gabapentinoid dependency Opioid dependency: number of people prescribed  an opioid at an average daily dose of opioid equivalent to ≥ 120mg per day of morphine over the previous 6 months as a percentage of all people prescribed step 2 and strong opioids†
Polypharmacy Opioid and gabapentinoid dependency Opioid dependency: number of people prescribed strong opioids (including tramadol preparations) long term (>2 years) as a percentage of all people prescribed strong opioids
Polypharmacy Poor Asthma Control Poor Asthma Control: number of people prescribed more than 12 short-acting beta-agonist (SABA) inhalers per annum as a percentage of all people prescribed SABAs
Respiratory Inhaled Corticosteroids Inhaled Corticosteroids: number of people prescribed >14 inhaled corticosteroid inhalers per annum as a % of all people prescribed inhaled corticosteroid inhalers
Respiratory Mucolytics Mucolytics: number of people prescribed mucolytics long term (> 2 years) per 1,000 LS*
Wounds Antimicrobial Wound Products Antimicrobial Wound Products: Antimicrobial wound products as percentage of total wound products (items)

Note 1 *these measures will also be made available using the population figures that have been weighted to account for prescribing need and are available within the PRISMS dataset

Note 2 LS – List Size

Note 3 † this indicator will also be made available with lower thresholds

Note 4 Indicator Types: Rx = prescriptions; Pts = people

Note 5 DDD: The defined daily dose (DDD) is an world-wide unit of measurement. The DDD value is the assumed average maintenance dose per day for a medicine when used for its main indication in adults. A medicine can have different DDDs depending on the route of administration.

 

Published 20/08/18