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How one ICB achieved a 7.4% reduction in antibiotic course length
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NHS Hertfordshire and West Essex ICB had an immediate 7.4% drop in antibiotic course length using an on-screen prompt at the point of prescribing — with a further 2% drop every month thereafter.
On-screen prompts at the point of prescribing help steer prescribers towards choices that uphold the highest standards of patient care and medication safety [1] . This is particularly important when considering the variation in adherence to prescribing short course antibiotics. By supporting better prescribing choices, ScriptSwitch® Prescribing - Clinical Decision Support plays a key role in helping to sustain the effectiveness of essential antibiotic medications.
Quantity Limits have been instrumental in helping to deliver on one of the national medicines optimisation opportunities this year."
The challenge
The National Institute for Clinical Evidence (NICE) [2] has been advocating a move towards the shortest effective course of antibiotics for appropriate conditions and patients for some time. However, primary care data indicate considerable variation in the uptake of prescribing short course antibiotics (as seen on OpenPrescribing). NHS England launched 16 national medicines optimisation opportunities for the NHS to deliver in 2023/24, including reducing course length of antimicrobial prescribing [3]. The practicality of doing this in primary care is a challenge due to large variability in prescribing practices [4]. Translating the recommendations into the prescribing workflow presents an opportunity to integrate the evidence-based guidelines into the decision-making process at the point of care.
The solution
Integrated within ScriptSwitch Prescribing is Quantity Limits, to address the volume of certain products being prescribed. It offers prescribers a suggested limit to the quantity being issued. One of the suggestions is for antibiotic course length for treating uncomplicated infections, supporting the NHS England recommendations to sustain the effectiveness of essential antibiotic medications.
The analysis
- The Optum Data Science Unit (DSU) used interrupted time series (ITS) autoregressive integrated moving average (ARIMA) modelling to measure the step change and slope of proportion of limit breaching prescriptions post intervention (Quantity Limits switch). Step change indicates the immediate effect of the intervention and slope indicates the month-by-month change following intervention.
- Following the implementation of the intervention from ScriptSwitch Prescribing, the volume of antibiotic prescriptions dramatically reduced, more than what we would expect if the intervention hadn’t been implemented.
- To substantiate these claims and show generalisability, a further 4 ICBs formed part of the analysis. They implemented the same Quantity Limits switch across their estate and the post intervention drop was analysed. There were statistically significant decreases in limit breaching antibiotic prescriptions in three out of four ICBs and in all ICBs with at least four months’ worth of prescribing data post deployment of the feature.
Conclusion
The ScriptSwitch Prescribing Quantity Limits switch has led to a statistically significant reduction in proportions of limit-breaching prescriptions in multiple, independent ICB settings throughout England. These results show that ScriptSwitch Prescribing is currently helping to sustain the effectiveness of essential antibiotic medications.
References
[1] Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS): multicentre, three arm, cluster randomised controlled trial BMJ. August 2016. and What Evidence Supports the Use of Computerized Alerts and Prompts to Improve Clinicians’ Prescribing Behavior? National Library of Medicine. July-August 2009.
[2] Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use NICE guideline [NG15]. August 2015.
[3] National medicines optimisation opportunities 2023/24 NHS England. July 2023.
[4] Krockow EM, Harvey EJ, Ashiru-Oredope D. Addressing long-term and repeat antibiotic prescriptions in primary care: considerations for a behavioural approach BMJ Quality and Safety. June 2022.