Using data to drive change

What is it?

• An indicator of clinical practice
• National Therapeutic Indicators (NTIs), use prescription data to provide a measure of prescribing activity in specified therapeutic areas for comparison across NHS Boards, Health and Social Care Partnerships (HSCPs), GP clusters and GP practices
• The most up to date national therapeutic indicator data is available here

Who can access/use?

• Open access to anyone
• Available here

Why? What for?

• NTIs benchmark prescribing across set parameters (usually defined by expert working groups to identify areas for improvement within a particular area)
• Data is presented in a variety of ways
• Examining variation over time and can indicate where improvements in prescribing can be made
• Indicator detail provides further detail and suggested actions

Example

• Both charts below show a reduction over time in the quantity of sulfonylureas, but the second chart shows clearly to NHS boards where review of prescribing may be required in comparison with the Scottish average. 
• Prescribers can then identify individuals who may require a change to their current medication using the Scottish Therapeutics Utility (STU) at an individual practice level. This allows changes to be made in the individuals clinical record.

Number of people aged 75 years or over prescribed sulfonylureas as a percentage of all people aged 75 years prescribed an anti-diabetic drug

What is it?

• A system to identify individuals in general practice, according to a set of pre-defined parameters, such as prescribing and clinical data (including read coding)
• STU focuses on identifying people to improve prescribing practice and improve medication safety

Who can access/use?

• GP practice staff only
• Instructions and download information is available here

Why? What for?

• STU was developed to improve safety, optimise efficiency and reduce avoidable waste (processes and costs), particularly in relation to repeat prescribing
• The utility allows users to interrogate their prescribing data in real time and provides graphs to identify trends in repeat prescribing
• STU includes reports which identifies areas of high risk prescribing to support clinicians in reviewing individuals at risk to determine if prescribing is necessary, or how the risk can be reduced

Example

• The diabetes indicators (developed from the NTIs and prescribing guide) highlight the number of people in each indicator. From each indicator title, the names of individuals are shown and their precribing record summarised below.
• STU has the facility to open the patient record to allow changes directly in EMIS or Vision. Sample database screenshot below.
• A sample STU screenshot is shown below below

What is it?

• Discovery is an information system that provides approved users from the Scottish Government, Health Boards, Local Authorities and Health & Social Care Partnerships with access to a range of comparative healthcare information to support performance and quality improvement across Health & Social Care in Scotland
• There is a prescribing dashboard with measures including: polypharmacy, primary and secondary care expenditure and secondary care use of medicines (HMUD)

Who can access/use?

• NHS staff (including board staff, GPs), Public Health Scotland (PHS) and Scottish government
• There are different security levels - Level 1 goes to board level, Level 2 goes to general practice level

Why? What for?

• Discovery provides comparative and benchmarking information to underpin service planning and delivery

Example

The example below is a screenshot showing the polypharmacy dashboard

What is it?

• SCI-Diabetes is the national clinical system for supporting diabetes care within NHS Scotland

Who can access/use?

• NHS Staff including board staff and GPs
• SCI-Diabetes provides a single diabetes system for NHS Scotland
• Users are aligned to ‘Domains’, which are cohorts of patients under the care of a particular clinic or service
• Patients and users can be aligned to multiple domains
• Access to the application is managed by administrators within each NHS board

Why? What for?

• SCI-Diabetes delivers a shared electronic record for use by all involved in the provision of diabetes care
• SCI-Diabetes provides modules of multi-speciality input for diabetes care from:
  • Primary care (complementary to GP system)
  • Adult hospital clinicians
  • Paediatrics – including transitional care
  • Diabetic specialist nursing
  • Dietitians
  • Podiatry
• SCI-Diabetes also provides support for
  • Service improvement
  • Local and national reporting
  • Research

Example

The example below is from the SCI-Diabetes Clinical Summary Page.