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Your Local Prescribing Advisor

Local prescribing advisor video with Dr Iain Carr
Well, I guess the next level is to go to prescribing advisors who can ask much more targeted questions and start going into the minutiae of practice here, and thinking about, well, despite the fact that we’re a good practice, could we be even better. I think that’s where your role comes in. I think a lot of the top line data can be used to ask really interesting questions. Where it gets even more interesting is where you come and look at the clinical system. And you can get some really specific points to start answering some questions and generate some more specific questions about practice. So, who are we giving these antibiotics to? You can look at the age range.
You can look at which particular clinicians are giving the drugs. You could look at the gender, the people being prescribed more. And you can get some really specific data to start asking some really specific questions around who are giving these antibiotics to. When are we giving them? And then you can go and have a look at some much more specific case reviews to really, really get to grips with what’s happening in terms of antibiotics prescribing in a particular practice at a particular time. So Ian’s put together some slides. Now, these can be done pretty much in real time in meetings, which is quite nice. Yeah. We found that really useful.
Once you’ve got the information at the clinical system, you can present it in lots of different ways and really answer questions as they’re coming up. Let’s say what percentage of women aged 20 to 40– so young women– what percentage do you think would have had an antibiotic? Difficult one. 10%? I’d go between 10% and maybe 20%. I was going towards 10%. So if you look here, it’s 27%. And we see that that’s low actually, compared to– that’s pretty standard for– all practices see the same thing. And so here we can see a breakdown by age and sex, and just the percentage of people having antibiotics. So let’s look at that demographic. So this is young women again.
What antibiotics are you giving? So we can see that the biggest, as you would probably expect, the number one antibiotic is trimethoprim, which is first line formulary choice for UTIs. And then flucloxacillin and doxycycline, presumably for skin and soft tissue infections. And then quite a lot of amoxicillin. It’s across the board, isn’t it? And a lot of UTIs, but a lot of amoxicillin as well. I’m really surprised at that because yes, I can get trimethoprim. But I just think that age group and antibiotics, amoxicillin. Usually they’re mothers with a young family, have to get on with life. Or is it the opposite thinking? Is that actually to get on with life, I supposedly need antibiotics.
I think that’s a really interesting observation, actually. I think it brings us into patient expectations and what they want. And I think there’s lots of things tied up in there. And that’s exactly what this data should do. So, generate more specific questions. Why is this particular group getting that particular antibiotic? What this does is it just starts asking those questions. Certainly when we– this person is seen in all other practices. One of the questions that people have said in the past is amoxicillin, is that all for gynae stuff? Is that the reason there’s a lot of amoxicillin in this age group? The only way to address that is to go and look at the cases.
But I also like when we do prescribe, I do like the sheet that you manage to put across on to our systems, so that actually when you do prescribe that you’ve got this little sheet that you give to the patient. I think that’s really good for patient information. That’s the link for the amoxicillin prescription? Yes. Absolutely. Is this the non-prescribing leaflets? Yes. I think it’s really good for the patient. And so when I– if I do prescribe an antibiotic, then I’ll staple it together and then give it to the patient. I think especially with the just in case scrips, it’s really helpful. [INAUDIBLE] Absolutely. The delayed scrips, yeah. Yeah, absolutely.
So this is the Public Health England leaflet on delayed prescribing that you’ve managed to put on systemwide. Yes, so they have a template on the system now that allows them to print it out for the patient. And it gives every antibiotic now, which is really good. So I think that’s a good way forward. Great. There’s another bit of data. before we move on data now, but there’s a little bit of data here on who prescribed what and when. The highest bars are the nurse prescribers. Well, I think you’ll find that’s probably because they’re in the same day team. And they’re working the same day team every morning and afternoon, every day of the week.
Whereas the GPs will be taking it in turns and only doing one or two sessions a week. And all of the minor illness. Yes.

Prescribing advisors are able to look deeper into your practice data as they can look at the clinical systems.

Detailed information can be reported on to answer very specific questions about antibiotic prescribing. For example age and gender can be examined alongside the usage by specific clinicians.

In this video clip Iain Carr, the Clinical Commissioning Group (CCG) pharmacist prescribing advisor who works with practices to review their antibiotic prescribing data discusses the data analysis that he and his colleagues can perform to monitor prescribing activity.

Watch the video and if you would like to see the graphs referred to in more detail they can be downloaded below.

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TARGET Antibiotics – Prescribing in Primary Care

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