A guest blog from Dr. Kevin Barrett (Twitter @DrKBarrett).
Last week the British Journal of General Practice published our paper on unsafe prescribing of methotrexate. As part of the publication Dr. Kevin Barrett talked to BJGP (see video below) about how he used OpenPrescribing to identify potentially unsafe prescribing in his practice and has also written a short blog below.
When I first started as a GP trainee in 1999 electronic prescribing was a relatively recent innovation. The practice formulary was built by hand, and prescribing analysis only occurred when paper Prescribing Analysis and CosT (PACT) reports were sent to the practice. These evolved into ePACT reports, but these still required time to decipher. With the advent of Primary Care Trust (PCT) and then Clinical Commissioning Group (CCG) employed pharmacists who had the time to analyse the data and present practice- and prescriber-level data to us at a range of meetings we became used to comparing our prescribing data to our peers. Electronic prescribing aids are a useful measure to help guide our prescribing and keep us up to date with the ever-changing local and national recommendations.
When I heard about OpenPrescribing.net I was initially overwhelmed by the amount of data available, and spent a while exploring which can be off-putting for busy clinicians. However I then discovered that OpenPrescribing prioritises areas for action as well as producing a bespoke monthly email alert for my practice. I find the monthly summary report emails really useful – they provide a snapshot of areas of interest and one can soon see the areas where work has taken place, where changes in staff have occurred, and where the occasional blip occurs. An example of the latter is a patient who joined our practice who had previously been prescribed 10mg methotrexate tablets. Following a significant incident many years ago my practice has a policy to only prescribe 2.5mg methotrexate tablets to reduce the risk of unintended harm. The new patient’s records were sent electronically and the 10mg dose was overlooked. It was only when the OpenPrescribing.net email came through that it came to light, and we were able to run a search, contact the patient, explain the rationale for the change and implement it.
Knowing that this data is public and open to scrutiny by our patients is an additional incentive to improve both the cost-effectiveness and safety of our prescribing. Most of my clinical colleagues are competitive; knowing that one is being compared to neighbouring practices, those in your PCN and those across the local area is a driver for us to use this data effectively.
The trends in prescribing over several years is a strength of OpenPrescribing.net. One-off snapshots are useful but projects such as high-strength opiate reduction regimes can take years to implement fully; colleagues who have started doing this in their surgeries can track the impact they are having.
Prescribing in my practice is far from perfect, but we are using OpenPrescribing.net to identify areas where we can make changes. It is a powerful tool that I would encourage others to use.
You can read the full paper and access more videos on BJGP Life about putting our methotrexate research into practice.