Pilot of national audit of primary care management of ... · Pilot of national audit of primary care management of commonly encountered ... COPD Community acquired pneumonia UTI ...

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


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


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


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


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


SCI-Gateway

Data entry screen


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


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 %


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


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


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


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

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