Using primary care data for medicines optimisation and safer prescribing Lauren Fensome PRIMIS This session has been financially sponsored by BI. Editorial

Using primary care data for medicines optimisation and safer prescribing

Lauren FensomePRIMIS

PRIMIS

This session has been financially sponsored by BI. Editorial control has remained with PRIMIS but the content has gone through a medical/compliance review by BI.

Pharmacy Management Regional Roadshow – Bristol 16th September

This symposium has been funded by Boehringer Ingelheim

UK/GEN-151027b September 2015

PRIMIS is a leader in extracting knowledge and value from primary care data, helping to achieve better health outcomes across the UK

PRIMIS is a business unit of The University of Nottingham

PRIMIS produces highly effective and practical solutions to help people access, understand and use patient data held on GP IT systems by providing:

• Software and audit tools

• Membership, training and consultancy services



Free audit tools available from PRIMIS

• GRASP-AF

• GRASP-COPD

• GRASP-HF

• Diabetes Care

• Warfarin Patient Safety

• Asthma Care

Downloads by audit (2015)

Audit CCGs PracticesGRASP AF 204 3105GRASP COPD 196 2174GRASP HF 182 1489Warfarin Patient Safety 187 1639Diabetes Care 180 1310Asthma Care 178 1198

There are 211 CCGs in England covering over 7,600 practicesUK/GEN-151027b September 2015

Key changes – GRASP AF

• Driven by CHA2DS2-VASc in support of NICE

• Includes all OACs• Additional functionality within data views


Key changes – Warfarin Patient Safety


CHART online – Warfarin Patient Safety


GRASP AF top usersNHS Aylesbury Vale CCGNHS Barnet CCGNHS Barnsley CCGNHS Blackpool CCGNHS Bolton CCGNHS Chiltern CCGNHS Fylde & Wyre CCGNHS Hambleton, Richmondshire and Whitby CCGNHS Hardwick CCGNHS Lancashire North CCGNHS Luton CCGNHS Mansfield and Ashfield CCGNHS North & West Reading CCGNHS North Derbyshire CCGNHS Salford CCGNHS South Eastern Hampshire CCGNHS South West Lincolnshire CCGNHS Southport and Formby CCGNHS Sunderland CCGNHS Walsall CCGNHS West Hampshire CCGNHS West Leicestershire CCG



Luton CCG case study

• The objectives for patient care were:– earlier detection of AF, through raised awareness in clinical

practice– better stroke prevention management using the CHADS2

scoring system (and moving towards use of CHA2DS2VASc)

– reduced AF-related stroke and mortality and the consequences of these on their family, carers, finance and community

• The objectives for the NHS were:– increase detection of undiagnosed AF– improved stroke prevention in AF– reduced AF-related stroke and subsequent cost of care– reduced AF-related stroke admissions to secondary care

• Practices were incentivised • Collaborative approach


Project Implementation

• Awareness sessions for clinicians• Training workshops for practice

administration staff– Install and run AF case finder and GRASP

AF– Analyse and interpret practice results– Re-audit

• Project management from CCG• Project support from SCN


Project outcomes

AF prevalence rose by 23%

Some practices increased their anticoagulant prescribing for high risk patients by 10%

Across the CCG, oral anticoagulant prescribing increased by 2.53%

Shone the light on skill set disparities across practice staff, which affected practice results

Improved data quality – a number of patients were found not to have AF

Consequently, some practices actually reduced prescribing of oral anticoagulants due to the systematic reviewing of the diagnosis of patients on the AF register



Blackpool CCG case study• Population 172,500• Mortality rates for CVD amongst the highest in the country• Life expectancy is the lowest in the country for men and third worst for women• One of the top 5 most deprived wards in the country • NST for health inequalities visit in 2009 highlighted the following as areas for improvement i. Secondary prevention of CVDii. Additional treatment for hypertensioniii. Warfarin for AF in >65’s

Project Implementation

• Informatics Development Team (Louise Gore)

Supported practices in downloading, installing and running the tool

• Medicines Management (Chris Hill)• Clinical Redesign Manager (Jeannie

Hayhurst)Provided clinical support to practices through the delivery of training and circulation of

information packs


Project outcomes

Initial results (April 2012)Increased prevalence of AF – 1.6% - 1.75% in first 12/12Increase of 19% in warfarin prescribing Numbers of high risk patients treated with aspirin or nothing also increased Conclusion - More education needed.

Latest results (June 2014)GRASP tools have been run quarterly since, now run remotely by Staffordshire and Lancashire CSUAF prevalence 2.24%Warfarin px increased from 40.51% (2011) to 63.27% (2014)


GRASP COPD top users

NHS Aylesbury Vale CCGNHS South Eastern Hampshire CCGNHS Chiltern CCGNHS Blackpool CCGNHS Bolton CCGNHS Fareham and Gosport CCGNHS Fylde & Wyre CCGNHS Newbury and District CCGNHS North & West Reading CCGNHS South Reading CCGNHS Trafford CCGNHS Walsall CCGNHS Wokingham CCG




An example of implementing GRASP COPD

to improve patient care


• An innovative 2 year Local Incentive Scheme • Objectives to:

– decrease unplanned admissions and– highlight patients with a primary diagnosis of COPD

• 3 Components– GP to attend monthly Locality commissioning meeting– Casefinder and GRASP-COPD use and monthly reporting– Practice action planning to improve patient care

• Practice managers were up skilled to run GRASP• Clinical templates were designed for use in consultation


• Prevalence rate for COPD has risen to 2.4%• Significant improvements in the classification of severity • At the end of 2013/14 admission data shows a reduction of 1.2% overall

which is a reduction of three hospital spells at the CCG expected average of 12.99%

• The focus of the 2014/15 LIS is that GP practices will be provided with a dashboard and summary sheet detailing the results of the 2013/14 data quality audits and highlighting areas for the practice to address over the coming year


What do these projects have in common?

• Clinical Champion• Stakeholder engagement• Local Incentive Scheme• What are the added benefits?• Education• Facilitation• Feedback







Asthma case finder: datasheet



Asthma care: datasheet


Asthma care: datasheet


Questions


Documents

Using primary care data for medicines optimisation and safer prescribing Lauren Fensome PRIMIS This session has been financially sponsored by BI. Editorial