Wide variance in safety indicator drug monitoring by GP practices in England and Wales revealed in new data

Disparity found in analysis of practice data from CCGs using First Databank’s prescribing decision tool.
By Tammy Lovell
02:16 AM

Drug and medical device knowledge company First Databank (FDB) is urging GP practices to standardise their approaches to routine testing and monitoring of drugs, after its data revealed variance in compliance across key safety indicators for drug prescriptions.

The firm’s OptimiseRx tool, which is used by two thirds of Clinical Commissioning Groups (CCGs) in England and Wales, prompts prescribers to monitor patients if evidence of routine drug monitoring recommended by Royal College of General Practitioners (RCGP) safety indicators is not found in the patient record.

According to an FDB press release, the figures from analysis of OptimiseRx usage in 2018/2019 “suggest the need for prescribers to increase essential routine testing of clinical markers for patient harm from medications, and for more robust recording of test results into the primary care clinical system.”

WHY IT MATTERS

For the mood stabiliser lithium, monitoring prompts through OptimiseRx arose for an average 3% of prescriptions against the relevant RCGP indicator where no evidence of test results were found in the previous six months.

Conversely, for amiodarone prescriptions where its side-effects are of continuing clinical concern, prescribers were alerted on more than one in five occasions to the absence of a thyroid function test being recorded.

Prompting for appropriate monitoring of liver function in the same patient group was lower, with 16% of prescriptions not having evidence of liver function tests recorded in the previous nine months.

Prescribers of ACE inhibitors and ARB medication were prompted just under 3% of occasions where they were identified as not meeting monitoring test criteria in relation to kidney function, like urea and electrolytes, within the last fifteen months.

But in relation to diabetic patients taking metformin there was an 8.5% incidence of serum creatinine tests - a monitor for potential kidney impairment - being missed or not recorded within the necessary 12-month period.

THE LARGER CONTEXT

FDB recently announced a partnership with healthcare interoperability startup Redox to support its web-based platform Meducation SMART on FHIR application, which helps patients with medication instructions.

ON THE RECORD

Dr Simon Hendricks, FDB product innovation manager, said: “Our new analysis of drug prescribing patterns across practices in England and Wales shows quite dramatic differences in evidence that essential monitoring tests are being undertaken.

“This may be partly a reflection of the management of patients across care settings and shared care arrangements or simply a variation in how reliable systems are for practices entering on patient records when a test has been carried out.

“Further work, in partnership with other relevant organisations, will uncover whether the absence of routine ordering of tests for one medication correlates with an absence of processes relating to drug therapeutic monitoring and recording of results in general.”