NHS England has published 16 national medicines optimisation opportunities for 2023/24, ICBs are recommended to choose at least 5 of these to focus on alongside their local medicines optimisation priorities. At Ardens, we have many resources to aid you with implementation of some of these opportunities and this article is an illustration of the areas relevant to primary care.
1. Addressing problematic polypharmacy
Within the Prescribing Alerts folder in Clinical Reporting there are reports which will help identify patients that will most benefit from an SMR including those on 10 or more medications, those with severe frailty, those on medications commonly associated with medication errors or that can cause dependence or withdrawal e.g. opioids, gabapentinoids, benzodiazepines and z-drugs.
These can be found in the following folders: Repeat medication, Frailty or Potentially Addictive.
The Drug Review template has a Polypharmacy page which can support the documentation of a review once you have identified the relevant cohort of patients:
2. Addressing low priority prescribing
Within the Prescribing | PPA Finance Environment folder there are reports which can help you to identify patients who may be being prescribed medications that are not appropriate or only appropriate in exceptional circumstances. These patients can then be reviewed:
7. Addressing inappropriate antidepressant prescribing
The Antidepressant Monitoring template guides you through all the steps of initiation, monitoring and stopping antidepressants:
8. Appropriate prescribing and supply of blood glucose and ketone meters, and testing strips
The Glucose Monitoring template guides you to select whether the patient is eligible for SMBG or CGM. The formulary has been developed using the Commissioning recommendations following the national assessment of blood glucose and ketone meters, testing strips and lancets, NHS England:
9. Identifying patients with atrial fibrillation (AF) and using best value direct-acting oral anticoagulants
The Atrial Fibrillation Formulary template follows NICE guidance:
There are also reports to help identify patients that should be prescribed an anticoagulant or have AF coded, these can be found in Conditions | Cardiovascular | Alerts and Conditions | Cardiovascular | Case Finder sections:
10. Identifying patients with hypertension and starting hypertensives when appropriate
The Community Pharmacy Services Template has a page where you can refer patients to the Hypertension Case Finding Service within community pharmacies.
The Hypertension Formulary guides you on the correct prescribing which follows NICE guidance:
11. Improving respiratory outcomes while reducing the carbon emissions from inhalers
The Asthma and COPD templates have tick boxes reminding you to offer patients a DPI rather than an MDI, to discuss the environmental impact of inhalers and to recycle their inhaler.
There are reports which can be found in the Conditions | Respiratory | Alerts, to identify patients who may be overusing SABA inhalers:
The Inhaler Technique and Devices template can aid with discussions around improving technique.
12. Improving valproate safety
The Valproate Monitoring template can assist you to ensure all the requirements around discussing contraception are met and recorded appropriately:
There are reports to identify any patients that may require a review, these can be found in the Prescribing Alerts folder under Neurology:
13. Optimising lipid management for cardiovascular disease prevention
The CVD Prevention template is available along with CVD Primary and Secondary Prevention Formularies:
14. Reducing course length of antimicrobial prescribing
All the conditions infections templates follow NICE/PHE guidelines, including duration of prescriptions generated. For example, the Impetigo template has information on the formulary to state that 5 days is appropriate for most people and this can be increased to 7 days based on clinical judgement. Prescribers are then given the choice of 5 or 7 days when issuing an antibiotic.
There is a report available which can be found in Clinical Reporting > Prescribing | Alerts > Infections > On antibiotic | On repeat and no indication in the last 1y which can be run to check that all patients that have antibiotics on repeat have an appropriate reason code added within the past year.
15. Reducing opioid use in chronic non-cancer pain
The Opioid Initiation & Monitoring template has recently been reviewed and helps you to manage the process of initiating, monitoring, and converting opioids for your patients:
There are reports available in the Prescribing Alerts folder under the Potentially addictive category that can be run to identify patients who require review:
Please contact the Medicines team if you have any further queries or feedback on the Ardens resources: medicines-systmone@ardens.org.uk