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

Medicines Update Primary Care Supplement- No.2 (April 2015)

Prescribing Indicators 2015-16


The prescribing indicators for 2015-16 are broadly based on the National Therapeutic Indicators and the Additional Prescribing Measures.  These were developed at the end of 2014 by a reference group of representatives from Health Boards across Scotland (including Lead CHCP/CHP Sector Pharmacists from NHS GGC). 

Nationally prescribing indicators (known as National Therapeutic indicators (NTIs)) have been developed for 4 years initially as part of the Quality and Efficiency Programme of the Scottish Government Directorate for Health and Social Care and more recently as part of the Therapeutics Branch of the Scottish Government’s Quality Unit.  These indicators cover core therapeutic areas including proton pump inhibitors, corticosteroids, hypnotics/anxiolytics, analgesics, antibiotics, antidiabetic drugs, non-steroidal anti-inflammatory drugs and antimicrobial wound management products.

Prescribing Indicators for 2015-16 

GASTROINTESTINAL

1

Proton Pump Inhibitors

DDDs per 1,000 weighted list size per day

CARDIOVASCULAR

2

Lipid Regulating Drugs

Non-preferred list Lipid Regulating Drugs  as a percentage of all lipid-regulating drugs (BNF 2.12) (items)

RESPIRATORY

3

Corticosteroid Inhalers (High Strength)

High Strength Corticosteroid Inhalers as a percentage of all corticosteroid inhalers (items)*

CNS (PSYCHOTROPICS)

4

Hypnotics and Anxiolytics

DDDs per 1,000 weighted list size per day

CNS (PAIN)

5a

Opioid analgesics (Strong)

Strong opioids DDDs per 1,000 weighted list size per day

5b

Opioid analgesics (Step 2)

Step 2 Opioids other than strong opioids DDDs per 1,000 weighted list size per day

ANTIBIOTICS

6a

Antibiotics (Total)

Total antibiotic script items per 1,000 list size per day

6b

Antibiotics (4C)

4C antibiotics script items per 1,000 list size per 100 days

7

Antimicrobial Wound Products

Antimicrobial wound products as percentage of total wound products (items)

DIABETES

8

Antidiabetic Drugs (Metformin)

Metformin as percentage of all anti-diabetic drugs (DDDs)

MUSCULOSKELETAL, ANTI-INFLAMMATORIES & OSTEOPOROSIS

9a

NSAIDs including Cox-2 inhibitors (Total)

DDDs per 1,000 weighted list size per day

9b

NSAIDs including Cox-2 inhibitors (Preferred)

Ibuprofen and naproxen as a percentage of all NSAIDs (DDDs)

URINARY FREQUENCY, URGENCY AND INCONTINENCE

10

Antimuscarinics

DDDs per 1,000 weighted list size per day

*Fostair® excluded

Additional Prescribing Measures (APMs) complement the NTIs. Areas of analysis include patient safety measures (patient-level analysis of drug combinations that are known to increase the risk of adverse drug reactions), previous NTIs retained for use by some health boards, areas that compliment current NTIs and areas that are of interest but the measure is not sufficiently robust to have as an NTI.

Prescribing Measures for 2015-16

HIGH-RISK PRESCRIBING (EFIPPS MEASURES)

11a

Aspirin/clopidogrel

Prescribing to people concurrently prescribed an oral anticoagulant without gastroprotection

11b

Antipsychotic

Prescribing to people aged ³ 75 years

11c

NSAID

 

Prescribing to people aged  ³ 65 years concurrently prescribed an ACE inhibitor / angiotensin receptor blocker and a diuretic

11d

NSAID

Prescribing to people aged ³ 75 years without gastroprotection

11e

NSAID

 

Prescribing to people aged ³ 65 years concurrently prescribed aspirin / clopidogrel without gastroprotection

11f

NSAID

 

Prescribing to people concurrently prescribed an oral anticoagulant without gastroprotection

CARDIOVASCULAR

12

NOACs

 

Items (dabigatran, apixaban and rivaroxaban)prescribed as a % of all items prescribed in BNF 2.8.2

RESPIRATORY

13

Corticosteroid Inhalers (High Strength) in children

Under 12 years prescribed high strength corticosteroid inhalers as a % of all children prescribed inhaled corticosteroids

CNS (PAIN)

14

Morphine

% of all morphine, oxycodone, fentanyl, tapentadol, and hydromorphine prescribed (DDDs)

15

Tramadol

DDDs/1000 weighted list size

16

Gabapentin

% of gabapentanoids (DDDs)

17

Pregabalin

DDDs/1000 weighted list size

18

Dihydrocodeine

DDD/1000 weighted list size

19

Lidocaine plasters

Cost/1000 weighted list size

DIABETES

20

Self Monitoring of Blood Glucose

 

Cost of blood glucose test strips per patients treated for diabetes

Number of patients prescribed insulin not prescribed SMBG as a % of all patients prescribed insulin

People prescribed blood glucose test strips who are not prescribed treatments for diabetes (6.1.1 and/or 6.1.2) or are only prescribed metformin % of all people prescribed HBGM test strips

NEW MEDICINES

21

Black triangle meds

% of all meds from BNF chapters 1-7 & 9-13 (items)

In addition to the NTIs and APMs developed nationally there are some locally agreed indicators (non-preferred list lipid regulating drugs antimuscarinincs, pregabalin and lidocaine).
The baseline period for prescription data will be Oct-Dec 2014 to allow practices to agree prescribing actions in early 2015-16. Final achievement period will be Jan-Mar 2016 to allow practices the full year to complete prescribing actions.
GP practices will achieve the prescribing indicator if the shift in prescribing either:
- places them within the desired quartile of the baseline period
or
- is greater than 20% of the interquartile range of the baseline period and moving toward the desired quartile.
If the prescription data does not provide adequate evidence of change then GP practices will achieve the indicator if they submit a 5-point audit detailing the actions they have undertaken to achieve the agreed actions related to the prescribing indicator.
GP practices will achieve the prescribing measure if they submit a 5-point audit detailing the actions they have undertaken to achieve the agreed actions related to the prescribing measure.