295P Queen Elizabeth II Conference Centre London
Pharmacology 2015

 

The Role of Nationally Agreed Prescribing Indicators (NPIs) in promoting Prudent Prescribing as part of Prudent Healthcare in Wales

 

Introduction We have used agreed National Prescribing indicators (NPIs) in Wales to measure standards of safe, effective and cost-effective in primary care for benchmarking purposes, to help target appropriate educational and other interventions and to measure any subsequent improvements associated with these particular interventions as part of the Prudent Healthcareagenda in Wales.

 

TABLE 1: NATIONAL PRESCRIBING INDICATOR (NPI) 2013-2014 2014-2015
Low cost statins i.e. simvastatin, pravastatin &atorvastatin (% of statin items including simvastatin & ezetimibe combination products) 94 95
Antibiotics (items/1,000 STAR-PUs) 374 377
Quinolones (% of antibacterial items) 2.04 1.85
Cephalosporins (% of antibacterial items) 4.42 3.56
Co-amoxiclav (% of antibacterial items) 4.55 3.97
Morphine (% of strong opioid items) 53 57
Hypnotics & anxiolytics (ADQs/1,000 STAR-PUs) 3905 3642
NSAIDs (ADQs/1,000 STAR-PUs) 1854 1775
Ibuprofen & naproxen (% of NSAID items) 78 81
Dosulepin (Defined Daily Doses per 1,000 PUs) 57 44
Tramadol (Defined Daily Doses per 1000 patients) 788 708
Long-acting insulin analogues (% of total long & intermediate acting insulin items, excluding biphasics) 91 90

 

Methods NPIs were agreed by national consensus using different measures of prescribing volumes (e.g. amount per prescribing unit [PU] or Specific Therapeutic group Age -sex Related prescribing unit [STAR-PU]). Sixteen interactive case-based workshops in prudent prescribing were then delivered in Wales by staff of the All Wales Therapeutics and Toxicology Centre in 2014-15. In additiona range of educational resources were produced by the All Wales Prescribing Advisory Group and endorsed and disseminated via the All Wales Medicines Strategy Group to health professionals in the NHS in Wales.

Results The relevant NPIs and their corresponding values for 2013/14 &2014/15 are shown in Table 1. All NPIS moved in the desired direction to a greater or lesser extent, except for the total volume of antibiotic prescribing. However reductions wereseen in the NPIs measuringproportional use of certainantibiotics defined by WHO as “critically importantantibiotics (CIAs)”.

Discussion NPIs are an explicit national benchmark as well as a measure of the impact of applying clinical pharmacological principlesfor the purpose of positively influencing prescribingbehaviour. These principles were shared with health professionals in a series of interactive case-based “training the trainer” educational workshops facilitated by clinical pharmacologists and pharmacists. Further work is needed to examine whether such improvements in prudent prescribing can be maintained over the longer term in the NHS in Wales.