Domain 2:

Safety and Quality: Prescribing

How to Analyse the Data

Once you have got your data, you need to decide how accurately it reflects your prescribing, how comparable your data is with the average, and how your prescribing compares with other colleagues.

Long term medication accounts for around 90% of all prescribing costs, and the majority derives from the BNF Sections 1-4 (G-I, CVS, RS and CNS). Hospital policies may influence the drugs used: you may find that long term prescribing assigned to your cipher has been initiated by somebody else.

Conversely you will initiate most of the acute prescriptions on your own cipher: but whilst these are usually large numbers of short drug courses, they may have a smaller impact on costs but a larger impact on other issues such as antibiotic resistance.

Asking yourself the following questions should help you to decide.

Data Sources

Why did you choose this data source?

  • Ease of access
  • Reliability
  • Reflection of prescribing or dispensing

How accurately does it reflect your prescribing?

  • How are prescriptions assigned?
  • Are there locums in the practice?
  • Are there non principals in the practice?

How does your prescribing compare with that of your Practice as a whole?

  • Consider patient groups, age/sex structure and special interests
  • How much acute work do you do?
  • How many sessions do you work?

How does your prescribing compare with your CHP as a whole?

  • Consider the demographics of your population
  • Consider locality
  • Has your practice any special responsibilities e.g. nursing homes?

Is there a category or class about which further evaluation would be worthwhile? Why?

  • Biggest in terms of cost or number of items
  • Particular interest
  • Difference from norms

What outcome would you like to achieve?

  • More effective prescribing
  • Compliance with local/national guidelines or formulary
  • Reduced prescribing in a particular area
  • Improvements in patient care
  • Improvements in preventive prescribing

For the category or class that you have chosen to study in detail, we have suggested that you utilise the following structure for your analysis. (We have given some examples, and a template to help structure your analysis.)

  • Identify the drug on which most is spent from your prescribing budget, or which you prescribed most frequently
  • List the indications for which you use this drug
  • Comment on the efficacy of the drug for each indication
  • Comment on the safety of this drug
  • Comment on the cost effectiveness for each indication
  • Are there any alternatives, which you might consider?
  • Compare your prescribing with local or national guidance
  • Compare your use of this drug with your CHP / Scotland as a whole
  • Repeat this with the second and third most expensive, or most frequently used, drug
  • List any changes you wish to make
  • Identify any barriers that may make this change difficult

Scenario 1

Dr A looked at his SPA 1 data, and noticed that his gastrointestinal drugs were costing more than the average GP. He felt that his data did reasonably reflect his prescribing, and there were no special reasons to explain this. He therefore requested a PRISMS report, which suggested that he was prescribing a greater number of items in the proton pump inhibitor group than the average. He should now:

  • Consider in what circumstances he currently prescribes PPIs acutely
  • Consider his repeat prescribing of PPIs
  • Compare his indications with local or national policies
  • Consider whether he is using the most cost-effective drug in this class
  • List any changes he wishes to make
  • Identify any barriers that may make this change difficult

Scenario 2

Dr B, working for the out-of-hours service, prescribed co-amoxiclav for a chest infection in his patient. She subsequently developed an adverse drug reaction, becoming jaundiced. Dr B checked back through his consultations for his last 2 shifts, noting which antibiotics he had used. He should now:

  • List the antibiotics that he prescribed, and his indications
  • Consider how many different antibiotics he used
  • Consider the cost-effectiveness of his current choice of antibiotic for common conditions
  • Compare this with his local formulary or national guidance
  • List any changes he wishes to make
  • Identify any barriers that may make this change difficult
  • To make his analysis more powerful Dr B could also work with a small group of others in the out-of-hours service to identify the number of times each of them uses an antibiotic in (say ) 20 shifts, compare their range of drugs used and the indications which they recorded for each.

Scenario 3

Dr C had a patient who called one morning having fallen. On reviewing her medication Dr C was surprised to find that she had been taking diazepam regularly since the death of her husband some months previously. He discussed this with his team, and they supported his decision of auditing repeat requests for benzodiazepines. He should now:

  • Conduct his audit, and discuss it with his practice
  • Consider alternative therapies (not necessarily pharmacological) to benzodiazepines
  • List any changes he wishes to make
  • Consider how his repeat prescribing system might influence prescribing
  • Identify any barriers that may make this change difficult

Scenario 4

Dr D's prescribing adviser pointed out that his cardiovascular drug costs were particularly high. She suggested a PRISMS search, which demonstrated that statin prescribing costs were above the local and national average, although he had no excess of patients with either vascular disease or diabetes. The data further suggested that he was prescribing above average amounts of atorvastatin 10mg. He should now:

  • Consider the cost effectiveness of the products in this group
  • Consider his current policy on prescribing statins in primary prevention
  • Consider his statin prescribing in secondary prevention and diabetics
  • Consider whether his policy, if he has one, reflects Joint British Guidelines or QOF targets
  • List any changes he wishes to make
  • Identify any barriers that may make this change difficult

This page was last updated on: 15/05/2015