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Scottish Medicines Consortium Pilot of national audit of primary care management of commonly encountered infections William Malcolm Pharmaceutical Adviser, Health Protection Scotland On behalf of the Scottish Antimicrobial Prescribing Group
Transcript of Pilot of national audit of primary care management of ... · Pilot of national audit of primary...
Scottish Medicines Consortium
Pilot of national audit of primary care management of commonly encountered infectionsinfections
William Malcolm
Pharmaceutical Adviser, Health Protection Scotland
On behalf of the Scottish Antimicrobial Prescribing Group
Scottish Medicines Consortium
Background
• Scottish Antimicrobial Prescribing Group (SAPG) is a national multidisciplinary clinical forum
• Implement national improvement initiatives via a network of NHS board Antimicrobial Management Teams (AMTs)
• SAPG prioritised inappropriate use of broad spectrum antibiotics and reduced unnecessary prescribing
• Management of Infection Guidance for Primary Care (HPA) adopted 2009
Scottish Medicines Consortium
Primary Care prescribing in NHS Scotland
100,000
150,000
200,000
250,000
300,000
350,000
Ite
ms
3,000,000
3,500,000
4,000,000
4,500,000
Ite
ms
0
50,000
2006 2007 2008 2009 2010
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
2006 2007 2008 2009 2010
Ite
ms
0
50,000
100,000
150,000
200,000
250,000
2006 2007 2008 2009 2010
Ite
ms
Co-amoxiclav
Cephalosporins Fluoroquinolones
2,000,000
2,500,000
2006 2007 2008 2009 2010
All antibacterials
Scottish Medicines Consortium
AimTo develop a national data tool to collectinformation on primary care management ofcommonly encountered infections
– provide baseline qualitative information on primary care antibiotic use
– identify areas for quality improvement
Scottish Medicines Consortium
MethodsRecruitment of prescribers
• NHS board AMTs invited practices to participate
Study period
• Single week in February 2011
Data collection
• All consultations for acute infection
• Data entry via screen in SCI-Gateway
Data analysis
• Data transferred by e-message to national database
Reporting
• Participants received own data compared to nationalaverage
Scottish Medicines Consortium
SCI-Gateway
Data entry screen
Scottish Medicines Consortium
Results
• 99 Prescribers in 55 (5%) Scottish GP practices• 13 of 14 NHS Boards• Split across high/medium/low volume prescribers
• 1,733 consultations recorded• Antibiotic prescribed in 68% consultations
• No major areas of non compliance with choice of therapy guideline
• Duration were longer than recommended
Scottish Medicines Consortium
Number of consultations by infection
400
500
600
Nu
mb
er
of
co
nsu
ltati
on
s
60%
70%
80%
90%
100%
Cu
mu
lati
ve t
ota
l
0
100
200
300
Acute
cough/b
ronchiti
s
Phary
ngiti
s/s
ore
thro
at/to
nsilliti
s
UT
I fe
male
Oth
er
Rhin
osin
usiti
s,
acute
Cellu
litis
Otit
is m
edia
CO
PD
Com
munity
acquired
pneum
onia
UT
I m
ale
Impetig
o
Pyelo
nephritis
Otit
is e
xte
rna
Infection
Nu
mb
er
of
co
nsu
ltati
on
s
0%
10%
20%
30%
40%
50%
Cu
mu
lati
ve t
ota
l
Number of consultations Cumulative %
Scottish Medicines Consortium
Upper respiratory tract infection
30%
40%
50%
60%
% o
f co
nsu
ltati
on
s
Delayed prescription
0%
10%
20%
30%
Acu
te
co
ug
h/b
ron
ch
itis
Ph
ary
ng
itis
/so
re
thro
at/to
nsillitis
Otitis m
ed
ia
Rh
ino
sin
usitis
,
acu
te
% o
f co
nsu
ltati
on
s
No prescription
Scottish Medicines Consortium
Views of participants• Response rate 54%
– 40% had changed their practice
– 62% 1 week data collection too short– 62% 1 week data collection too short
– 94% supported future audits
– 59% antibiotic prescribing was priority
– 72% used data for revalidation
Scottish Medicines Consortium
How have SAPG used the results?
• Confirmed that GPs have appetite for clinical audit in management of infection
• Identified over prescribing for URTI as key area • Identified over prescribing for URTI as key area for improvement
• Used results to develop a national prescribing indicator to reduce antibiotic use in primary care
Scottish Medicines Consortium
Acknowledgements
• Tracey Cromwell, Principal Information Analyst, Information Services ScotlandInformation Services Scotland
• Lynne Otterson, Systems Developer, Health Protection Scotland
• Graeme Bryson, Medicines Management Adviser, NHS Ayrshire & Arran
• Simon Hurding, General Practitioner, NHS Highland
