Using joined-up data to enhance prescribing practice for population health management
By Integrated Care Journal-
Integrated care systems have a key focus on improving population health outcomes and reducing health inequalities between different groups within their local area.
The development of primary care networks (PCNs) – a global policy initiative reported across more than 15 OECD countries, including the UK, Australia, France, Switzerland and the United States – is essential to supporting neighbourhood-level population health management within wider integrated care systems.
In the UK, as with other areas, PCNs have a key focus on supporting personalised care, including through the delivery of outcome-focused, structured medication reviews and supporting the safe and effective use of medicines, amongst other areas.
Prescribing, most of which is carried out in primary care settings, is one of the top healthcare interventions in the UK and accounts for around £20 billion, or c.15 per cent of the total NHS budget. It has a significant influence on health outcomes and inequalities, care experience and per capita costs of care. Improving medicines management and safety is not just a healthcare problem – there are significant public health implications from the practice of prescribing.
For example, antimicrobial resistance is a global health threat, prescribing for the primary prevention of cardiovascular disease (CVD) is one of the fastest ways to reduce health inequalities from cardiovascular disease, and there are concerning increasing trends in opioid prescribing and opioid-related deaths in England and globally, where drugs that cause dependency have an impact on family, work, health and wider life outcomes.
On the environmental agenda, the ambition to achieve a net-zero health service, where the NHS contributes around four to five per cent of the total UK carbon footprint, will also require a focus on tackling medicines waste, which accounts for around 20 per cent of NHS carbon emissions.
Between 30-50 per cent of medicines prescribed for those with long-term conditions are wasted (not taken as intended) and there is a clear need to use data-driven medicines optimisation solutions to understand medicines use and variation, support quality improvement, ‘do no harm’ from prescribing and support positive behaviour change for professionals and those prescribed medicines in order to improve outcomes relating to medicines use. There is strong evidence emerging that data-driven and electronic audit and feedback of prescribing data has a positive, cost-effective quality improvement effect on prescribing practice.
A Cochrane review of 140 randomised trials found that audit and feedback produced a median 4.3 per cent absolute improvement (interquartile range 0.5 per cent to 16 per cent) in health and care professionals’ compliance with desired practice, such as recommended prescribing. These improvement gains from audit and feedback may appear modest, but incremental gains through repeated improvement cycles can support system-level improvement at scale, for example, across an integrated care system (ICS).
ICSs could start by focusing on two or three prioritised medicines-related areas across their PCN teams, identifying and addressing unwarranted variation through learning what works and what doesn’t across networks to support quality improvement, and scale from there.
Prescribing data from a single data source only (for example, in-hours general practice data) is likely to under-report prescribing activity and outcomes compared with joined-up data from multiple sources in venues where prescribing occurs. These can be community pharmacies, community services and wider secondary/tertiary services, and where biopsychosocial outcomes from prescribing may be documented.
Scalable and programmable population health platforms that securely connect data from multiple sources in near-real time from a range of settings are required to give a joined-up, standardised and system-level view of medicines and prescribing activity – not just for professionals, but increasingly for citizens.
This joined-up view of an individual’s medication in the context of the care they receive, their care record and documentation will be critical in supporting safe and effective medicines use, personalised care and integrated digital medicines management, as well as assisting applications that help understand and optimise individual health outcomes that may be influenced by medicines use, both positively and negatively.
In future, these advantages will extend to personalised prescribing, research, development and interventions tailored to individual biopsychosocial factors in the real-world setting – not just for medicines, but wider ‘prescriptions’ related to the social and wider determinants of health.
How Cerner can help
Cerner’s UK health network team provide data-driven transformation services leveraging the Cerner suite of population health and healthcare technology solutions to support improved medicines management and safety across ICSs and PCNs.
Our offer to clients:
Identification of system-level prescribing use cases and mapped data sources
Cerner-powered medicines management and safety improvement programmes including person-level case finding tools to support point of care management improved patient engagement
Cerner-powered medicines use and variation analysis, including PCN educational outreach and service evaluation
About the author
Ryan Irwin is a population health strategy executive at Cerner with a particular interest in primary care quality improvement and population health management. He has wide experience across health and care strategy, development, and delivery, -sector health and care organisations. Ryan has a clinical background with a BSc (Hons) in Physiotherapy and academically holds an MSc, MPA and PhD across areas including health and care strategy, policy, management and quality improvement.
References available upon request.
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