Using prescribing data to improve patient outcomes and align with NHS priorities

An interview with Sarah Jarman, FDB OptimiseRx Consultant Clinical Pharmacist

We talk to Sarah Jarman, Consultant Clinical Pharmacist at FDB and member of the OptimiseRx team about the new developments to enhance messages within the solution and align with NHS priorities.

Hi Sarah, we understand you’ve been working on some new clinical developments within OptimiseRx?
Yes, that’s right! We always work really hard to make sure we are ahead of the curve here at FDB and with our team of pharmacists, expert informaticians and clinicians, it’s what we’ve been doing for over 40 years! One of the areas we’ve been focusing on recently are enhanced self-care messages within OptimiseRx, which will benefit users and patients alike. OptimiseRx is our leading medicines optimisation solution which delivers best practice guidance at the point of care, and currently supports over 42 million patients through their GP practices.

The OptimiseRx team clinical team at FDB wanted to enhance the experience for prescribers, commissioners and patients alike, and we’re really pleased to have succeeded in creating more targeted messages within the self-care section of OptimiseRx.

Can you tell us a bit more about self-care messages and how they fit in the NHS and integrated care landscape?
Of course! ‘Self-care’ messages are a massively hot topic for NHS prescribing, particularly in the current climate. As a bit of background, from December 2017 to March 2018, NHS England carried out a public consultation looking at ‘reducing prescribing of over-the-counter medicines for minor, short-term health concerns.’ This work was published in report ‘Conditions for which over the counter items should not routinely be prescribed in primary care’. Wales carried out a similar exercise, resulting in the ‘All Wales common ailments policy’. Both these pieces of work resulted in the creation of a list of conditions that can be treated by self-care and don’t necessarily need a prescription and can be treated by medicines that are available to buy for the patient over the counter (OTC). As part of these directives, we had built self-care messages into OptimiseRx.

That sounds helpful! So why did you need to work on these messages?
These messages can be quite regular for GPs and prescribers, which can cause what is known as ‘alert fatigue’. This means that prescribers could potentially miss really important messages. Prescribers are also often under pressure, the patient is in front of them, and it can be hard to say ‘no’ to patients: all of which means targeted messages would benefit users.

Before we carried out the work to enhance the self-care messages, we did lots of background analysis and talked to our NHS clients about their requirements and sensitivities. For example, if a prescriber is seeing a patient with a long-term condition or a serious illness, which makes the patient unsuitable for self-care, we didn’t want the GP to receive a message interrupting consultation time. We wondered how we could use OptimiseRx prescribing data to improve this, trying to be really targeted in messages, while reducing the possibility of alert fatigue. We were also thinking about patients and how their care experience could be enhanced, whilst also considering how we could support all the different integrated care boards (ICBs) and their goals, of which saving money is a key element. So we had the patient, the prescriber and the commissioner in our heads all the time we were doing this work. And while there are cost avoidance benefits for the NHS using this approach, there’s the more altruistic side too and thinking of patients, because we really care about the patient and user experience.

What did you actually do?
Our pharmacist led project team built logic into OptimiseRx to enable messages to be targeted at patients and their condition and situation – so there is a real element of patient-specificity.

The team proactively looks at messages and data insights – as well as the NHS considerations.

To start with, we worked out which conditions or patient groups were appropriate to exclude from these messages, using NHS England and the All Wales Medicines Strategy Group (AWMSG) guidance. We then looked at performance data and analysed the hit count and offer rate, as well as the acceptance and rejection rates and reasons, and the number of customers using these messages. We then analysed the prescriber reasons for rejecting these OTC products and which products had been rejected the most.

What are the benefits of new messaging in OptimiseRx?
The OptimiseRx team are constantly improving messages and user experience. Self-care messages are now honed so that the message is displayed with appropriate patients, providing advice to manage minor conditions at home with self-care. This also mean that for patients who have a relevant long-term condition or serious illness the messages will automatically be hidden.

There are also cost avoidance messages so users can see savings, while message triggers are customisable in the portal, so that users can choose the most appropriate messages to enable in their profile.

We are really pleased with the results of this work! Since we’ve honed these messages, the hit count has reduced by over 145,000 nationally, while the acceptance rate average increased by over 4%. We were able to equate this to a cost avoidance to the NHS which increased by £78,000, which is fantastic news. We’ve also had a lot of positive feedback from our users to these messages.

What advice have you given to customers about these updated messages?
We are encouraging people to consider enabling the self-care messages in their profiles, if they haven’t already. I’d also encourage users to identify messages that meet their local priorities and to talk to their practices and prescribers and use rejection reasons. There is growing evidence that working at engagement across all levels of the ICB will see improved results.

Thanks very much!