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  1. Posted
    Categories
    • OpenPrescribing

    Dispensing data shows huge variation in Out of Pocket Expenses

    Each year, we estimate there are up to £5m of Out of Pocket Expenses (OOPE) expenses charged to the NHS, added by dispensing contractors to their invoices. Could some of these expenses be reduced? In 2014/15 NHS Islington CCG wrote to dispensing contractors highlighting such expenses, and from this single intervention achieved a 50% reduction; spread across the country this could amount to a saving of £2.5m.

    We’ve done some initial investigations, but don’t have resources to follow up in detail. This post is to note what we’ve found so far. If you are interested in finding out more, and have access to funding, let us know!

  2. Posted
    Categories
    • OpenPathology

    2018 Round-Up

    In our third full year of existence we produced even more exciting outputs and continued to grow. We welcomed Lydia Berry, back from maternity leave; Dave Evans, Consultant Programmer, who joined the OpenPrescribing technical team; and Brian MacKenna, an Honorary Research Fellow Pharmacist and member of the NHS England Medicines and Diagnostics Policy Unit. We also welcomed Darren Smyth, a UK and European Patent Attorney - our work so far includes our pregabalin papers (here and here), and he has also contributed to our EUCTR work.

  3. Posted
    Categories
    • Research Integrity

    New Lawsuit Against US Government Cites FDAAA Tracker

    Earlier this week, the Media, Freedom & Information Access Clinic at Yale Law School filed a lawsuit against the heads of the Department of Health and Human Services, the NIH, and the FDA over their interpretation and implementation of trial reporting provisions in the FDA Amendments Act of 2007 (FDAAA 2007). The lawsuit was filed on behalf of Charles Seife, a journalist and NYU professor, and Dr. Peter Lurie, President of the Center for Science in the Public Interest.

  4. Posted
    Categories
    • OpenPrescribing

    OpenPrescribing December 2018 Newsletter

    New “do not prescribe” measures on OpenPrescribing.net

    At OpenPrescribing we pride ourselves on developing our tools in response to the needs of our users. Last week NHS England announced a new “Do Not Prescribe” list for consultation. Within an hour we made graphs showing every GP practice’s prescribing of these items. You can drill down to CCG level, and then practice level.

    We hope that this data will be useful for clinicians and CCG pharmacists to identify where there is most room for improvement, or change. Or, to drive discussion about agreement on the guidance.

  5. Posted
    Categories
    • OpenPrescribing

    Price Concessions Calculator — A New Feature on OpenPrescribing

    This week we launched a new feature on OpenPrescribing, an NHS Price Concession calculator. We show the cost impact of price concessions for the whole of England here and the calculator appears on every single practice and CCG dashboard so you can work out the impact locally.

    What are price concessions and what are the broader issues?

    Price concessions are a short term agreement by the NHS to pay more than the already agreed price for a generic medicine because pharmacists are unable to obtain the generic at its usual price. Regular readers of our blog will remember a series of blogs last year (see archive) where we detailed the issues and this led to the development of our magnificent Drug Tariff and Concession Viewer, which shows the prices over time for each individual drug, automatically updated on a daily basis.

  6. Posted
    Categories
    • OpenPrescribing

    New measures for latest "Do Not Prescribe" list under consultation

    Earlier this week NHS England announced a new “Do Not Prescribe” list for consultation.

    Within an hour we made graphs showing every GP practice’s prescribing of these items. You can drill down to CCG level, and then practice level.

    We hope that this data will be useful for clinicians and CCG pharmacists to identify where there is most room for improvement, or change. Or, to drive discussion about agreement on the guidance.

  7. Posted
    Categories
    • OpenPrescribing

    Limitations of NHS England prescribing data

    The data that drives OpenPrescribing is described briefly in our FAQ. It is supplied by NHSBSA and NHS Digital, and a few other sources.

    Over the years we have come to understand the limitations of this data. We’re sharing them here, so researchers can take them into account when carrying out analyses.

    When using Practice Level Prescribing Data, bear in mind:

    • The data relates to primary care prescribing only. Secondary care prescribing is not included. In many cases however, ongoing care is largely managed in primary care, so meaningful analyses are still possible
    • The data originates from reimbursement claims from dispensing contractors (such as pharmacies), and therefore does not include prescriptions which are issued but never dispensed
    • As the data is from reimbursement claims, items are recorded for the month in which their costs were claimed by the contractor, which may be several months after they were prescribed (blog)
    • As the data is captured for reimbursement use, there is no way of knowing the indication of the prescription for patients
    • The data is for items which were prescribed by practices in England and dispensed in the UK
    • The data is aggregated to practice level. No data is released for tracking at a patient or GP level
    • The data only describes what was on the prescription form, not what was actually dispensed. For example, items which were prescribed generically may be dispensed as brands.
    • The quantity field is occasionally expressed inconsistently (e.g. sometimes doses, sometimes packs) (notes)
    • Item figures do not provide any indication of the length of treatment or quantity of medicine prescribed. Patients with a long term condition usually get regular prescriptions. While many prescriptions are for one month (28 or 30 days supply), items will be for varying length of treatment and quantity
    • BNF codes change over time. We have attempted to account for this (notes)
    • It can be important to know whether an institution is a standard GP practice, or a different kind of institution (for example, a homeless service, or a drop-in centre). However, in the data provided, there is a small but significant number of obvious errors in coding, such as classification of Care Homes and Violent Patient Services as standard settings, and arbitrary numbers given where the list size is less than 100 or unknown (notes)
    • Some CCGs have “rebates” agreed with pharmaceutical companies, and therefore the net cost will be less. This is not reflected in the prescribing data, as it is a separate income stream to the organisation
    • Closures and mergers are not tracked. Therefore it can be difficult to know where patients have gone when a practice is closed, particularly if there is not a single merger. If analysing at a CCG level it is usually safe to assume the majority of patients remain within the same CCG, though this is not always the case
    • CCGs and practices therein change over time; to project back in time consistently, we show current CCGs and the practices they currently contain (rather than the CCG they were in at the time)

    When using list size (e.g. as denominator):

  8. Posted
    Categories
    • OpenPrescribing

    OpenPrescribing October 2018 Newsletter

    All England Dashboard - A New Feature on OpenPrescribing.net

    At OpenPrescribing we pride ourselves on developing our tools in response to the needs of our users. OpenPrescribing is being increasingly used at national organisations and we have had many requests for an All England dashboard. This month we launched the first version of the All England dashboard and blogged about it here.

    Phenytoin Supply Disruption Alert

    At the Bennett Institute we get many emails about how people are using OpenPrescribing and this month we blogged about how OpenPrescribing can be helpful when medicines are in short supply. Epanutin (phenytoin) 30mg/5ml oral suspension is currently subject to a Supply Disruption Alert and it is very important that patients are identified promptly and their prescriptions are modified if appropriate. To read more about the alert and how OpenPrescribing can be helpful please see the blog here. If you have any other interesting usecases please get in touch at feedback@openprescribing.net

  9. Posted
    Categories
    • OpenPrescribing

    Phenytoin Supply Disruption Alert

    Drug supply issues are an interesting use-case for OpenPrescribing. Here we will talk about a recent example.

    What is the problem?

    Last week the Department of Health and Social Care issued a “Supply Disruption Alert” for Epanutin (phenytoin) 30mg/5ml oral suspension: Pfizer, the manufacturer, will be out of stock of this product from the week commencing 29th October (today) until early December 2018. This means people currently taking Epanutin (phenytoin) 30mg/5ml oral suspension may need to be prescribed a different product.

  10. Posted
    Categories
    • OpenPrescribing

    All England Dashboard - A New Feature on OpenPrescribing.net

    This week we have launched a new page on OpenPrescribing.net, the All England dashboard, that allows anyone to see the quality of prescribing at a national level. For the first time we have aggregated all the savings from all our measures in one place. For the month of August these numbers are quite staggering:

    • £13,190,000 - could potentially have been saved if CCGs used our innovative price-per-unit tool (you can read our methods paper here).

  11. Posted
    Categories
    • Research Integrity

    IQWiG Response to the EU TrialsTracker

    The EU TrialsTracker, which provides the results reporting status of every trial on the EU Clinical Trials Registry, launched last week alongside a paper in the BMJ. We already shared some of the media coverage from the launch of the tracker and comments from Norman Lamb MP, Chair of the House of Commons Science and Technology Committee and Fergus Sweeney, Head of Inspections, Human Medicines Pharmacovigilance and Committees at EMA.

    Today we wanted to share a statement, released on Friday, from the Institute for Quality and Efficiency in Health Care (IQWiG) in Germany. For those that are not familiar, IQWiG is the German institute responsible for assessing the quality and efficiency of medical interventions, similar to the role NICE plays in the UK. We were pleased to see a government institute calling explicitly for better results reporting from publicly-funded institutions. IQWiG offers frank experiences from their own work in which withheld data compromised their ability to properly assess the evidence for treatments under review. The director of IQWiG, Jürgen Windeler, specifically calls for a system that checks “whether an applicant has completely reported its previously funded project in the EU Register and, if applicable, refuse further funding.”

  12. Posted
    Categories
    • Research Integrity

    The EU TrialsTracker is Live!

    Earlier this year we launched our FDAAA TrialsTracker, providing a live look at whether individual sponsors and trialists are meeting their responsibility to report the results of clinical trials on ClinicalTrials.gov. Now we have launched the EU TrialsTracker. This new tracker shows the results status for every trial on the EU Clinical Trials Registry (EUCTR). We are launching the tracker alongside a paper in the BMJ providing a detailed overview of our methods, an analysis of the factors associated with non-reporting and a discussion of the data issues that make assessing compliance difficult on EUCTR.

  13. Posted
    Categories
    • TrialsTracker

    TrialsTracker Project Wins Cochrane-REWARD Prize for Reducing Research Waste

    Our FDAAA TrialsTracker has been updating each working day since February showing which trials on ClinicalTrials.gov have reported, in compliance with the FDA Amendments Act of 2007. Our newly launched EU TrialsTracker and paper in the BMJ show exactly which trials on the EUCTR have reported according to EU guidelines.

    This week we’re delighted to tell you that our TrialsTracker work has been awarded a Cochrane-REWARD Prize for Reducing Research Waste. We’re honored to share the 2nd prize with the wonderful James Lind Alliance; and further humbled to finish behind the mighty EQUATOR Network, who took a well-deserved 1st prize for their continued work on improving the quality of trial reporting.

  16. Posted
    Categories
    • OpenPrescribing

    Could North Cumbria save money on haemorrhoid cream?

    Last week, a pharmacist from NHS North Cumbria CCG got our attention by mentioning OpenPrescribing on Twitter. He had just received a letter about a product for treating haemorrhoids called Uniroid. It’s a 50/50 mixture of Cinchocaine and Hydrocortisone, and is also available as Proctosedyl (made by Sanofi), and as a generic (i.e. unbranded) product.

    The maker of Uniroid wants North Cumbria to start prescribing Uniroid-branded products, on the grounds it will save the CCG about £11,000 per year.

  17. Posted
    Categories
    • OpenPrescribing

    Smoothing seasonality - your feedback needed

    Recently we created antimicrobial stewardship dashboards for every Clinical Commissioning Group and General Practice in England by grouping our measures (see our blog post here).

    We received feedback from users that some of our measures are difficult to understand, because they exhibit a high level of seasonal variation. Antibiotics show the most seasonality amongst our measures (e.g. openprescribing.net/measure/ktt9_antibiotics). As you can see below, it takes a lot of staring at this graph to work out whether the deciles (blue lines) are going up or down overall, and whether the red line (the data from a single CCG) is changing in relation to them.

  18. Posted
    Categories
    • OpenPrescribing

    OpenPrescribing July 2018 newsletter

    This newsletter was sent out on Thurs, Jul 26; sign up to receive the next one at www.openprescribing.net

    We do the stats to make your life easy…

    At OpenPrescribing we hide complicated data science “under the bonnet”: we want data to be easy, to come alive and tap you on the shoulder when there’s a problem. As you know we have an “alerts” service, open and free to anyone, that emails you if there’s a new issue with the prescribing at any practice. But how does it all work? Making a tool that sends an alert when a practice hits the highest 10% in the country for a given prescribing measure was easy. But we wanted to spot problems and send alerts much sooner than that: when a practice begins to drift in comparison to its peers over time, well before it becomes an extreme outlier. Our most recent paper shows the inner workings of this service. If you’re really geeky, you can read the paper here. Or you can just sign up and use the service!