Improving antibiotic prescribing in primary care in NHS Grampian

Transcription

1 Improving antibiotic prescribing in primary care in NHS Grampian Gillian Macartney Specialist Antibiotic Pharmacist With acknowledgements to Joan Macleod, CHP Pharmacist Aberdeen City North Cluster

2 Who has made interventions? Antimicrobial Management Team Antibiotic Working Group CHP and Practice Pharmacists Individual Prescribers

3 AMT Strategy Development and dissemination of empirical guidelines Participation in training sessions Answering queries

4 Antibiotic Working Group Members: Consultant in Pharmaceutical Public Health, GP, Prescribing Advisor, Microbiologist, Nurse Prescriber, Community Pharmacist, Corporate Communications Winter Pack Public Campaign Education/Training Sessions

5 Example chart

6 CHP Pharmacist Interventions GP Contract Actions ScriptSwitch GPs asked to flag inappropriate requests from secondary care Review of antibiotic Rx in care homes Promotion of empirical guidelines at every opportunity!

7 GP Contract: Prescribing Advisor Topics Action 1 Antibacterials (Key NHSG aim is to reduce antibiotic prescribing in general but particularly the 4C antibiotics) a) Retrospective audit of ~ 1week antibiotic prescribing Feedback to GPs on practice & individual GP results. Meet with lead or practice pharmacist - further actions as a result of audit to be discussed and agreed. b) New NHS-G Primary Care Antibiotic guidance to be circulated c) Prescribing Indicators: reduce antibiotic indicators (from Oct-Dec 09 data)

8 a) Audit Report for GPs Prescribing data compared with other practices Antibiotics used practice data Indications practice data Antibiotics and indications individual prescriber data Appropriateness

9 Antibiotics prescribed June Trimethoprim Amoxicillin 4 Doxycycline Penicillin Flucloxacillin Nitrofurantoin 5 Metronidazole 11 Co-amoxiclav Erythromycin 5 Clarithromycin Lymecycline Oxytetracycline Azithromycin 7 10 Tetracycline Cefradine 8

10 Indication for Prescribed Antibiotic UTI 4% 4% 4% 3% 3% 26% Cellulitis LRTI Skin/superficial tissue infection A nti-malarial 4% A cne/rosacea Tonsillitis 5% Genital tract Infections H. Pylori Eradication 5% 10% Sore Throat/Cough URTI 5% Sinusitis 5% 7% 7% 8% Misc Otitis media Dental Infection

11 Appropriateness Indication Antibiotic No. of Rx Appropriate? UTI Trimethoprim Nitrofurantoin Cefradine YES YES (2 nd line) NO Cellulitis Flucloxacillin Penicillin V 4 3 YES NO LRTI Amoxicillin Clarithromycin 4 2 YES NO Skin/ superficial tissue infection Flucloxacillin Erythromycin Co-Amoxiclav YES YES NO

12 c) Prescribing Indicators Prescribing Indicators for Grampian 2010/11 Target Q Q Q Q Q ANTIBIOTICS: DDDs per 1000 weighted patients Reduce rate of increase QUINOLONES: DDD s per 1000 weighted patients Downward trend QUINOLONES: Items per 1000 weighted patients Downward trend NEW 7 COAMOXICLAV: DDD s per 1000 weighted patients COAMOXICLAV: Items per 1000 weighted patients Downward trend Downward trend NEW 6

13 ScriptSwitch Message facility to help with cost savings in VISION practices) Used to highlight the 4C antibiotics to GPs at the point of prescribing Between 1 st May and 31 st July 2010 ciprofloxacin message was activated 1600 times and 236 times (15%) the prescriber chose not to continue to prescribe ciprofloxacin

14 Individual Prescribers Review of antibiotic prescribing for GP appraisals Organising/attending training events Querying best choice of antibiotic Querying secondary care requests Feedback about guidelines

15 It s working!!

16 Primary Care 4C prescribing

17 Reduction of C diff in Grampian

18 Grampian Acute Hospitals 4C s vs C diff 60 NHS Grampian Acute Hospitals - 4Cs as a percentage of all antibiotics vs. Total number of CDI cases - March June percentage (%) number of CDI cases Cs as a % of all abs Total number of CDI cases Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 M onth-year Source: Report Plus, 2010 and PAS, 2010