NIHR: Decision support tools can help GPs reduce antibiotic prescriptions for respiratory conditions

NIHR | May 2019 | Decision support tools can help GPs reduce antibiotic prescriptions for respiratory conditions

National Institute for Health Research (NIHR) funded a trial which has shown a 12% reduction in GP antibiotic rates for respiratory conditions through electronic decision and training tools. The Signal from NIHR indicates that there was a reduction in prescriptions for patients between 15 and 84 were but there was no observed difference in younger children and older adults.

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Read the full Signal from NIHR 

Gulliford, M. et al. 2019| Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care: REDUCE cluster randomised trial| BMJ |364 | doi: https://doi.org/10.1136/bmj.l236 

OBJECTIVES: To evaluate the effectiveness and safety at population scale of electronically delivered prescribing feedback and decision support interventions at reducing antibiotic prescribing for self limiting respiratory tract infections.

DESIGN: Open label, two arm, cluster randomised controlled trial.

SETTING: UK general practices in the Clinical Practice Research Datalink, randomised between 11 November 2015 and 9 August 2016, with final follow-up on 9 August 2017.

PARTICIPANTS: 79 general practices (582 675 patient years) randomised (1:1) to antimicrobial stewardship (AMS) intervention or usual care.

INTERVENTIONS: AMS intervention comprised a brief training webinar, automated monthly feedback reports of antibiotic prescribing, and electronic decision support tools to inform appropriate prescribing over 12 months. Intervention components were delivered electronically, supported by a local practice champion nominated for the trial.

MAIN OUTCOME MEASURES: Primary outcome was the rate of antibiotic prescriptions for respiratory tract infections from electronic health records. Serious bacterial complications were evaluated for safety. Analysis was by Poisson regression with general practice as a random effect, adjusting for covariates. Prespecified subgroup analyses by age group were reported.

RESULTS: The trial included 41 AMS practices (323 155 patient years) and 38 usual care practices (259 520 patient years). Unadjusted and adjusted rate ratios for antibiotic prescribing were 0.89, respectively, with prescribing rates of 98.7 per 1000 patient years for AMS (31 907 prescriptions) and 107.6 per 1000 patient years for usual care (27 923 prescriptions). Antibiotic prescribing was reduced most in adults aged 15-84 years, with one antibiotic prescription per year avoided for every 62 patients (95% confidence interval 40 to 200). There was no evidence of effect for children younger than 15 years or people aged 85 years and older; there was also no evidence of an increase in serious bacterial complications.

CONCLUSIONS: Electronically delivered interventions, integrated into practice workflow, result in moderate reductions of antibiotic prescribing for respiratory tract infections in adults, which are likely to be of importance for public health. Antibiotic prescribing to very young or old patients requires further evaluation.

The journal article is available from the BMJ 

Biosimilar medicine

NHS England | June 2019 | Biosimilar medicine

NHS England has produced What is a Biosimilar medicine? – which provides an update for key clinical and non-clinical stakeholders about the role of biosimilar medicines in the NHS in England and to support the safe, effective and consistent use of all biological medicines, including biosimilar medicines, to the benefit of patients (Source: NHS England).

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What is a Biosimilar medicine? 

Investigation into penalty charge notices in healthcare

Department of Health & Social Care, NHS England &  NHS Business Services Authority | May 2019 | Investigation into penalty charge notices in healthcare

An investigation undertaken by the Department of Health & Social Care, NHS England &  NHS Business Services Authority, examines the health sector’s use of penalty charge notices
(PCNs). PCNs are sent to those who have claimed a free prescription or dental treatment
when they were not entitled to do so; or have a valid exemption which cannot be
confirmed at the time of checking. The NHS Business Services Authority (NHSBSA),
which administers PCNs, has three main aims in relation to charges for prescriptions
and dental treatment:
• to recover costs erroneously paid by the NHS;
• to deter and reduce fraud; and
• to ensure people are better

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The report recommends a simpler system or better real-time checking will be important going forward in deterring fraud but not disadvantaging vulnerable people.

 

 

Full report- Investigation into penalty charge notices in healthcare

Summary- investigation into penalty charges in healthcare

Press release

More prescriptions issued in 2018

NHS Digital | March 2019 |Prescription Cost Analysis – England, 2018 [PAS]

Prescription Cost Analysis (PCA), analyis conducted by Office for National Statistics shows that in the calendar year 2018, the cost of prescriptions dispensed in the community was £8.8 billion an increase of 2.9 million prescription items dispensed in the community. This shows a decrease of 3.7% (£336.6 million) from £9.2 billion in 2017 (Source: NHS Digital). 

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Responding to an increase in the numbers of antidepressants prescribed, Professor Helen Stokes-Lampard, Chair of the Royal College of GPs said:

“Antidepressants are no different, and it’s really important that increasing numbers of antidepressant prescriptions are not automatically seen as a bad thing, as research has shown they can be very effective drugs when used appropriately.

“It can be difficult to determine why prescribing rates fluctuate, these figures could indicate rising awareness of mental health conditions in society, and that more patients are feeling able to seek medical care for them – as well as demonstrating an improvement in the identification and diagnosis of mental health conditions (Source: RCGP).

NHS Digital Prescription Cost Analysis- England 2018, [PAS] 

Rising prescription numbers not ‘automatically a bad thing’, says RCGP

Prescription Cost Analysis 2018- Report

Prescription Cost Analysis 2018- Factsheet 

In the news:

BBC News Jump in antidepressant prescriptions in England

The Guardian Antidepressant prescriptions in England double in a decade

Items which should not routinely be prescribed in primary care: an update and a consultation on further guidance for CCGs

NHS England | November 2018 | Items which should not routinely be prescribed in primary care: an update and a consultation on further guidance for CCGs

NHS England are running a national consultation on items which should not routinely be prescribed in primary care (for example GP practices, pharmacies, the dentist, and 
eye clinics.) The consultation involves 9 medicines and products. According to NHS England, research shows that some medicines can be replaced with other medicines that
work better, are safer or cost less money.

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Overview Items which should not routinely be prescribed in primary care: an update and a consultation on further guidance for CCGs

Easy read version of the consultation document

Consultation document 

See also:

NHS Clinical Commissioners [press release]

Stopping fraud against the NHS: new plans announced

The government has announced how it will take tougher action on fraud and save hundreds of millions of pounds for the NHS over the next 5 years, increasing the money available for improving patient care | Department of Health and Social Care

The new approach will start with a commitment to halve prescription fraud, which costs the NHS £256 million a year. Prescription exemptions will be digitised, allowing pharmacies to check whether the patient does not have to pay charge before their medication is dispensed. cure-1006811_1920 This will be piloted next year, before being rolled out across the NHS. The focus on prescriptions is one aspect of a wider crackdown on NHS fraud, which will prevent up to £300 million being lost to fraud by April 2020.

Further measures being introduced to stop fraud include:

  • a new partnership between the NHS Counter Fraud Authority (NHSCFA) and the fraud prevention service Cifas, allowing NHS counter-fraud professionals to access Cifas data
  • more collaboration and data sharing between the NHS Business Services Authority and NHSCFA to identify the small number of pharmacists and dentists claiming payments for services they have not carried out
  • the introduction of a new counter-fraud profession in central government, bringing together around 10,000 counter-fraud specialists, including 400 focused on fraud in the NHS

Full detail at Department of Health and Social Care

Prescribing of over the counter medicines is changing

NHS England | August 2018 | Prescribing of over the counter medicines is changing

NHS England have produced a series of documents to support CCGs to implement recommendations and support discussions between patients and their healthcare professionals.

Quick Reference Guide for Healthcare Professionals: Items which should not routinely be prescribed in primary care

The Quick Reference Guide for Healthcare Professionals is a quick reference tools summarising the CCG guidance on Items which should not routinely be prescribed in primary care.

Interactive Quick Reference Guide for Healthcare Professionals: Items which should not routinely be prescribed in primary care

This an interactive, quick reference tool summarising the CCG guidance on Items which should not routinely be prescribed in primary care.

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There are also a series of patient information leaflets, including easy read leaflets

Patient information leaflet ‘Prescribing of over the counter medicines is changing’

A patient information leaflet to support discussions between patients and healthcare professionals

See NHS England for full details