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National Prescribing Indicators

National Prescribing Indicators
 
The All Wales Medicines Strategy Group (AWMSG) has endorsed the National Prescribing Indicators (NPIs) as a means of promoting safe and cost-effective prescribing since 2003. NPIs have historically focused on primary care prescribing; however, in 2015 a set of secondary care NPIs were developed by the All Wales Prescribing Advisory Group (AWPAG) and launched by AWMSG for use in 2016–2017. This report contains data relating to the primary and secondary care NPIs for the first quarter of 2017–2018. 
Background information supporting the choice of NPIs is detailed in the document National Prescribing Indicators 2017–2018 available from the AWMSG website. 

The National Prescribing Indicators 2017–2018: Analysis of Prescribing Data to June 2017 document has been prepared by the Welsh Analytical Prescribing Support Unit and can be accessed on the link below:
 
http://www.awmsg.org/docs/awmsg/medman/National%20Prescribing%20Indicators%202017-2018%20Analysis%20of%20Prescribing%20Data%20to%20June%202017.pdf


 PRIMARY CARE

For 2017–2018, there are 14 primary care NPIs focusing on seven areas of prescribing and the reporting of adverse events (Yellow Cards). Four of the indicators – high strength inhaled corticosteroids (ICS), opioid patches, anticholinergic burden, and non-steroidal anti-inflammatory drugs (NSAIDs) and chronic kidney disease (CKD) – are new for 2017–2018. A threshold level of prescribing/reporting is set for 11 of the 14 NPIs based upon quarter three data for 2016–2017. The threshold for the NSAIDs and CKD NPI has been based upon quarter one data for 2017–2018, due to the unavailability of historical data.

• Of the 12 NPIs with a threshold, there was an overall improvement (in line with the aim of each indicator) across Wales in 11 NPIs, compared with the equivalent quarter of the previous year (quarter ending September 2016), or quarter one 2017–2018 for NSAIDs and CKD. The NPI that did not show an improvement was gabapentin and pregabalin, where prescribing increased in all health boards
(8.11% national increase).

• At a national level, the NPIs associated with the largest improvements were:

– Yellow Card reporting by GPs increased by 61% compared with the equivalent quarter of the previous year, and Yellow Card reporting for all health board reporters increased by 42%.

– Number of patients on the CKD register (CKD stage 3–5) who have received a repeat prescription for an NSAID within the last 3 months, as a percentage of all patients on the CKD register (32.5% reduction, September quarter 2017 compared with June quarter 2017)

– Number of patients not on the CKD register but have an eGFR of < 59 ml/min, and have received a repeat prescription for an NSAID within the last 3 months, as a percentage of all patients who are not on the CKD register but have an eGFR of < 59 ml/min (28.7% reduction, September quarter 2017 compared with June quarter 2017).

– NSAIDs ADQs per 1,000 STAR-PUs (11.2% reduction, September quarter 2017 compared with the equivalent quarter of the previous year)

– Cephalosporin items per 1,000 patients (8.77% reduction, September quarter 2017 compared with the equivalent quarter of the previous year)