April 2017 Produced by the Prescribing Team
National Therapeutic Indicators (NTIs) and Additional Prescribing Measures (APMs) use prescription data to provide a measure of prescribing activity in specified therapeutic areas and a comparison across the GP practices in Scotland, Health Boards within Scotland and GP practices within these Health Boards. These are then used by Health Boards/Health and Social Care Partnerships to direct prescribing actions within GP practices and the work of managed service pharmacists and pharmacy technicians working within these practices.
Nationally prescribing indicators have been developed for 5 years initially as part of the Scottish Government Quality and Efficiency Programme from the Directorate for Health and Social Care and more recently as part of the Therapeutics Branch. These indicators cover core therapeutic areas including proton pump inhibitors, inhalers, hypnotics/anxiolytics, analgesics, antibiotics, antidiabetic drugs, non-steroidal anti-inflammatory drugs and antimicrobial wound management products.
The availability of patient-level data from the Prescription Information System provides an opportunity to develop measures that directly address patient safety issues, particularly the prescribing of drug combinations that are known to increase the risk of adverse drug reactions. As the capture of data required for this patient-level analysis (the CHI number) is not consistently high across all GP Practices in Scotland these are designated prescribing measures; they complement the indicators.
Other areas of analysis are designated prescribing measures where patient-level analysis encourages review (e.g. long-term antidepressants) or where the measure complements an indicator (e.g. encouraging the prescribing of 2mg diazepam tablets to support patient-centred management plans to reduce anxiolytic prescribing).
These NTIs and APMs for 2017-18 were developed at the end of 2016 by a reference group of representatives from Health Boards across Scotland. They reviewed prescribing trends including the changes in prescribing patterns that could be attributed to specific NTIs and APMs. They also considered national prescribing strategy documents and prescribing indicators used in other UK countries, most notably Wales.
The NTI for total antibiotic prescribing is used by Scottish Governments Directorates of Health and Social Care (SGDHSC) as a HEAT target in collaboration with the Scottish Antimicrobial Prescribing Group (SAPG). Many of the prescribing safety measures support the medication reviews recommended in the national polypharmacy strategy and other measures support the national diabetes, respiratory and chronic pain prescribing strategies.