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Opioids Prescribing: Outcome Measures

 

Indicator O1

Continuous prescribing of opiates for more than 12 months

 

More information about this indicator

Data Source: NHSBSA Information Services Data Warehouse

Time Period: April 2018 to February 2020  The data looks at the previous 13 months of prescribing, as far back as April 2017 to calculate the results, but is not reported on separately

Organisation Data: Data is restricted to prescriptions prescribed and dispensed in England

Drug Data: "The data shows patients who were prescribed substances from the Opioid Analgesics paragraph of the British National Formulary (BNF) (040702) Please note that since the implementation of the One Drug Database, the number of drugs encompassed by this definition has changed and therefore the historic numbers from DR1064 have also changed slightly. For more information on the One Drug Database implementation, see https://www.nhsbsa.nhs.uk/one-drug-database-odd-has-been-implemented"

Patient Counts: "The column 'Number of Unique Patients' shows a count of unique identified patients, for each month and CCG. To be counted, a patient must have been prescribed an Opioid Analgesic (as described above) in the listed month and also in each of the 12 previous months, giving them 13 months consecutive prescribing. This prescribing must have occurred in the same CCG to be counted.

For example, each of the patients recorded against Airedale, Wharfedale and Craven CCG for April 18 will have received an opioid analgesic prescription from a prescriber in Airedale, Wharfedale and Craven CCG in each of April 17, May 17, June 17, July 17, August 17, September 17, October 17, November 17, December 17, January 18, February 18, March 18 and April 18 (13 months)."

Note that a patient may appear in more than one CCG for the same month, in the instance that they meet the above criteria for more than one CCG

Exclusions: The data excludes:

  • Items not dispensed, disallowed and those returned to the contractor for further clarification.
  • Prescriptions prescribed and dispensed in Prisons, Hospitals and Private prescriptions.
  • Items prescribed but not presented for dispensing or not submitted to NHS Prescription Services by the dispenser

Data for this indicator has been sourced directly from NHSBSA Information Services: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

 

Indicator O2

High dose opioids as percentage regular opioids by all CCGs

 

More information about this indicator

Description: Opioids with likely daily dose of ≥120mg morphine equivalence compared with prescribing of all doses of these opioids

Why it matters: There is little evidence that opioids are helpful in long term pain, and the risk of harm increases significantly above 120mg morphine (or equivalent) per day, without much increase in benefit.

Please follow this link for a detailed technical specification

Data for this indicator has been sourced from openprescribing.net

 

Indicator O3

High dose opioids per 1000 patients by all CCGs

 

More information about this indicator

Description: Opioids with likely daily dose of ≥120mg morphine equivalence per 1000 patients

Assumption: If a patient is on regular doses of 120mg morphine a day or above that they are likely to have also had additional opioids for breakthrough pain.

This is why the threshold has been set at ≥120mg morphine equivalence per day. The calculations are based on likely doses of long acting, regular opioids, for example morphine sulphate tablets or fentanyl patches.

Please follow this link for a detailed technical specification

Data for this indicator has been sourced from openprescribing.net

 

Indicator O4

Opioids - total oral morphine equivalence by CCG (u-chart)

 

More information about this indicator

Description: Total opioid prescribing (as oral morphine equivalence) per 1000 patients

Why it matters: This measure describes the total Oral Morphine Equivalence (OME) in ALL opioid prescribing (excluding prescribing for addiction) including low-dose opioids in drugs such as co-codamol and co-dydramol.

Please follow this link for a detailed technical specification

Data for this indicator has been sourced from openprescribing.net

 

Opioids Prescribing: Balancing Measures

Opioids Prescribing: Balancing Measures

 

Indicator O5

Anxiolytics and Hypnotics - Average Daily Quantity per item by all CCGs

 

More information about this indicator

Description: Number of average daily quantities (ADQs) per item for anxiolytics and hypnotics

Why it matters: Anxiolytics and Hypnotics are drugs that are prescribed for short-term treatment of conditions such as anxiety and sleep problems.

This measure shows the mean Average Daily Quantity (ADQ) given per prescription, for both the older benzodiazepines, such as diazepam and temazepam, and the newer "Z-drugs", such as zopiclone.

It excludes items that do not have an ADQ, such as melatonin.

Please follow this link for a detailed technical specification

Data for this indicator has been sourced from openprescribing.net

 

 

Indicator O6

Prescribing of gabapentin and pregabalin (DDD) by all CCGs (i-chart)

 

More information about this indicator

Description: Total DDD of pregabalin + gabapentin per 1000 patients

Why it matters: Gabapentin and pregabalin are increasingly used in neuropathic and other types of pain, and use is rising rapidly in the NHS.

Defined Daily Dose (DDD): The assumed average maintenance dose per day for a drug used for its main indication in adults

Please follow this link for a detailed technical specification

Data for this indicator has been sourced from openprescribing.net

 

Indicator O7

Prescribing of pregabalin by all CCGs

 

More information about this indicator

Description: Prescribing of pregabalin per 1000 patients

Why it matters: Pregabalin is a relatively new drug, which is increasingly used in neuropathic and other types of pain. Also its costs have reduced recently, its use is rising increasingly rapidly in the NHS. There are also concerns about the potential for abuse.

Please follow this link for a detailed technical specification

Data for this indicator has been sourced from openprescribing.net

 

Polypharmacy Indicators

Polypharmacy Indicators

 

Indicator IP7

Average number of unique medicines per patient (i-chart)

 

More information about this indicator

Definition: Average number of unique medicines prescribed per patient (all, 65 and over, 75 and over, 85 and over).

Numerator: Total number of unique medicines prescribed for patients (all, 65 and over, 75 and over, 85.

Please follow this link for a detailed technical specification (page 8 of 23)

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

 

 

Indicator IP8

Percentage of patients prescribed 8≥ unique medicines

 

More information about this indicator

Definition: Number of patients (all, 65 and over, 75 and over, 85 and over) prescribed 8/10/15/20 or more unique medicines as a percentage of the number of patients prescribed one or more medicines

Numerator: Number of patients (all, 65 and over, 75 and over, 85 and over) prescribed 8/10/15/20 or more unique medicines from one or more of the following BNF Chapters in a single month.

Denominator: Total number of patients (all, 65 and over, 75 and over, 85 and over) prescribed one or more medicines within BNF chapters 1 to 4 and 6 to 10 during same time period as numerator.

Methodology: Numerator divided by denominator. Presented as a percentage

Please follow this link for a detailed technical specification (page 9 of 23)

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

 

Indicator IP10

Percentage of patients prescribed 10≥ unique medicines (p-chart)

 

More information about this indicator

Definition: Number of patients (all, 65 and over, 75 and over, 85 and over) prescribed 8/10/15/20 or more unique medicines as a percentage of the number of patients prescribed one or more medicines

Numerator: Number of patients (all, 65 and over, 75 and over, 85 and over) prescribed 8/10/15/20 or more unique medicines from one or more of the following BNF Chapters in a single month.

Denominator: Total number of patients (all, 65 and over, 75 and over, 85 and over) prescribed one or more medicines within BNF chapters 1 to 4 and 6 to 10 during same time period as numerator.

Methodology: Numerator divided by denominator. Presented as a percentage

Please follow this link for a detailed technical specification (page 9 of 23)

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

 

Indicator IP15

Percentage of patients prescribed 15 ≥ unique medicines

 

More information about this indicator

Definition: Number of patients (all, 65 and over, 75 and over, 85 and over) prescribed 8/10/15/20 or more unique medicines as a percentage of the number of patients prescribed one or more medicines

Numerator: Number of patients (all, 65 and over, 75 and over, 85 and over) prescribed 8/10/15/20 or more unique medicines from one or more of the following BNF Chapters in a single month.

Denominator: Total number of patients (all, 65 and over, 75 and over, 85 and over) prescribed one or more medicines within BNF chapters 1 to 4 and 6 to 10 during same time period as numerator.

Methodology: Numerator divided by denominator. Presented as a percentage

Please follow this link for a detailed technical specification (page 9 of 23)

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

 

Indicator IP20

Percentage of patients prescribed 20 ≥ unique medicines (p-chart)

 

More information about this indicator

Definition: Number of patients (all, 65 and over, 75 and over, 85 and over) prescribed 8/10/15/20 or more unique medicines as a percentage of the number of patients prescribed one or more medicines

Numerator: Number of patients (all, 65 and over, 75 and over, 85 and over) prescribed 8/10/15/20 or more unique medicines from one or more of the following BNF Chapters in a single month.

Denominator: Total number of patients (all, 65 and over, 75 and over, 85 and over) prescribed one or more medicines within BNF chapters 1 to 4 and 6 to 10 during same time period as numerator.

Methodology: Numerator divided by denominator. Presented as a percentage

Please follow this link for a detailed technical specification (page 9 of 23):

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

 

Anticoagulant Indicators

Anticoagulant Indicators

 

Indicator IP6

Multiple prescribing of anticoagulants and antiplatelet medicine

 

More information about this indicator

Definition: Patients (all, 65 and over, 75 and over, 85 and over) prescribed three or more unique medicines that have an anticoagulant or antiplatelet action as a percentage of patients prescribed one or more unique medicines that have an anticoagulant or antiplatelet action during the same reporting period.

Numerator: Number of patients (all, 65 and over, 75 and over, 85 and over) prescribed three or more unique medicines within a single month that have an anticoagulant or antiplatelet action and are included in one or more of the following BNF codes:

BNF Name: Oral Anticoagulants             BNF Code: 0208020

Excluding INR Blood Testing Reagents   BNF Code: 0208020W0

BNF Name: Antiplatelet Drugs               BNF Code: 0209000

Only aspirin 75mg presentations (BNF 2.9) are included in the numerator (BNF 209000). Whilst prescribers should be aware that other aspirin containing presentations (BNF 4.7.1 which includes aspirin 300mg) and Non-Steroidal Anti-inflammatory Drugs exert antiplatelet activity, they have been excluded from the numerator. These prescribing comparators should be viewed as developmental and the specifications will be reviewed over time.

Parenteral anticoagulants have also been excluded on the basis that they may be prescribed prior to commencing oral treatment and potentially captured in the same reporting period.

Denominator: Number of patients (all, 65 and over, 75 and over, 85 and over) prescribed one or more medicines that have an anticoagulant or antiplatelet action within same BNF areas as numerator during same time period as numerator.

Methodology: Numerator divided by denominator. Presented as a percentage

Please follow this link for a detailed technical specification ( on page 12 and 13 of this publication prepared by NHS BSA)

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

Indicator S2

GIB02:[Increased risk of hospital admission] Prescribed NSAID + oral anticoagulant (i-chart)

 

More information about this indicator

Title: GIB02 Patients aged 18 or over currently prescribed a non-steroidal anti-inflammatory drug (NSAID) and concurrently prescribed an oral anticoagulant (warfarin or a direct oral anticoagulant (DOAC)) and therefore potentially at increased risk of admission to hospital with a GI bleed

Definition: Number of patients aged 18 or over in the month of prescription currently prescribed a non-steroidal anti-inflammatory drug (NSAID) and concurrently prescribed an oral anticoagulant (warfarin or a direct oral anticoagulant (DOAC)) per 10,000 patients currently prescribed a NSAID or an oral anticoagulant.

Numerator: Patients aged 18 or over in the prescription month prescribed a nonsteroidal anti-inflammatory drug (NSAID) and concurrently prescribed an oral anticoagulant (warfarin or a direct oral anticoagulant) (DOAC)).

Denominator: Patients aged 18 or over in the prescription month prescribed a nonsteroidal anti-inflammatory drug (NSAID) or an oral anticoagulant (warfarin or a direct oral anticoagulant) (DOAC)).

Methodology: Numerator divided by denominator, presented per 10,000 patients.

Purpose: The purpose of the indicator is to quantify the number of patients taking a non-steroidal anti-inflammatory drug (NSAID) and concurrently taking an oral anticoagulant (warfarin or a direct oral anticoagulant) (DOAC)), and therefore potentially having an increased risk of a GI bleed, presented as a proportion (per 10,000) of patients taking a NSAID or an oral anticoagulant.

Reporting Level: Quarterly aggregate results at National, Regional and CCG level>

A detailed technical specification for this indicator is available from page 15 - 17 of this publication (prepared by NHS BSA)

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

Indicator S3

GIB03:[Increased risk of hospital admission] Prescribed an oral anticoagulant + anti-platelet without gastro-protection

 

More information about this indicator

Title: Patients aged 18 or over currently prescribed an oral anticoagulant (warfarin or a direct oral anticoagulant (DOAC)) with an anti-platelet and not concurrently prescribed a gastro-protective medicine and therefore potentially at increased risk of admission to hospital with a GI bleed.

Definition: Number of patients aged 18 or over in the month of prescription currently prescribed an oral anticoagulant (warfarin or a direct oral anticoagulant (NOAC)) with an anti-platelet and not concurrently prescribed a gastro-protective medicine per 10,000 patients currently prescribed an oral anticoagulant with an anti-platelet (with or without a gastro-protective medicine)

Numerator: Patients aged 18 or over in the prescription month prescribed a nonsteroidal anti-inflammatory drug (NSAID) and concurrently prescribed an oral anticoagulant (warfarin or a direct oral anticoagulant) (DOAC)).

Denominator: Patients aged 18 or over in the prescription month prescribed a nonsteroidal anti-inflammatory drug (NSAID) or an oral anticoagulant (warfarin or a direct oral anticoagulant) (DOAC)).

Methodology: Numerator divided by denominator, presented per 10,000 patients

Purpose: The purpose of the indicator is to quantify the number of patients taking an oral anticoagulant (warfarin or a direct oral anticoagulant (DOAC)) with an anti-platelet and not concurrently taking a gastro-protective medicine (and therefore potentially having an increased risk of a GI bleed), presented as a proportion (per 10,000) of patients taking an oral anticoagulant with an anti-platelet (with or without a gastro-protective medicine)

A detailed technical specification for this indicator is available from page 15 - 17 of this publication (prepared by NHS BSA)

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

Additional Similar 10 CCG

Gastrointestinal Bleed Risk

 

Indicator S1

GIB01:[Increased risk of hospital admission] Prescribed NSAID without gastro-protection

 

More information about this indicator

Title: GIB01 Patients aged 65 or over currently prescribed a non-steroidal anti-inflammatory drug (NSAID) without a gastro protective medicine and therefore potentially at increased risk of admission to hospital with a GI bleed.

Definition: Number of patients aged 65 or over in the month of prescription currently prescribed a non-steroidal anti-inflammatory drug (NSAID) without a gastro protective medicine per 10,000 patients currently prescribed a NSAID (with or without a gastro-protective)

Numerator: Patients aged 65 or over in the prescription month prescribed a nonsteroidal anti-inflammatory drug (NSAID) without a gastro protective medicine

Denominator: Patients aged 65 or over in the prescription month prescribed a nonsteroidal anti-inflammatory drug (NSAID) with or without a gastro-protective medicine).

Methodology: Numerator divided by denominator, presented per 10,000 patients.

Purpose: The purpose of the indicator is to quantify the number of patients who are prescribed a non-steroidal anti-inflammatory drug (NSAID) without a gastro-protective medicine, and therefore potentially having an increased risk of a GI bleed, presented as a proportion (per 10,000) of patients taking a NSAID with or without a gastro protective medicine.

Rationale: A non-steroidal anti-inflammatory drug (NSAID) prescribed without a gastro-protective medicine may increase the risk of a gastro-intestinal bleed.

Reporting Level: Quarterly aggregate results at National, Regional and CCG level>

A detailed technical specification for this indicator is available from page 15 - 17 of this publication (prepared by NHS BSA)

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

Indicator S4

GIB04:[Increased risk of hospital admission] Prescribed aspirin + anti-platelet without gastro-protection (i-chart)

 

More information about this indicator

Title: GIB04 Patients 18 years old or over prescribed aspirin and another anti-platelet and not concurrently prescribed a gastro-protective medicine and therefore potentially at increased risk of admission to hospital with a GI bleed.

Definition: Number of patients aged 18 or over in the month of prescription currently prescribed aspirin and another anti-platelet and not concurrently prescribed a gastro-protective medicine per 10,000 patients currently prescribed aspirin and an anti-platelet (with or without a gastro-protective medicine).

Numerator: Patients 18 years old or over prescribed aspirin and another anti-platelet and not concurrently prescribed a gastro-protective medicine. See admission rate indicator (denominator) for specifications of patient age group, non-steroidal anti-inflammatory drugs (NSAIDs) and gastro- protective medicines.

Denominator: Patients aged 18 or over in the prescription month prescribed aspirin and another anti-platelet (with or without a gastro-protective medicine). See admission rate indicator denominator) for specifications of patient age group and non-steroidal anti-inflammatory drugs (NSAIDs).

Methodology: Numerator divided by denominator, presented per 10,000 patients.

Purpose: The purpose of the indicator is to quantify the number of patients taking aspirin with another anti-platelet and not concurrently taking a gastroprotective medicine, and therefore potentially have an increased risk of a GI bleed, presented as a proportion (per 10,000) of patients taking aspirin with another anti-platelet (i.e. with or without a gastro-protective medicine).

Rationale: Aspirin and another anti-platelet prescribed together without a gastroprotective medicine may increase the risk of a gastro-intestinal bleed.

Reporting Level: Quarterly aggregate results at National, Regional and CCG level>

A detailed technical specification for this indicator is available from page 15 - 17 of this publication (prepared by NHS BSA)

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

Indicator S5

GIBCI:[Increased risk of hospital admission] Composite increased risk indicator - gastro-intestinal bleed

 

More information about this indicator

Title: The Composite Gastro Intestinal Bleeds comprising of unique patients from indicators 1 to 4

Definition: Composite Gastro Intestinal Bleeds comprising of unique patients from indicators GIB01 to GIB04

Numerator: Unique admissions from numerators of all four gastro-intestinal bleed indicators.

Denominator: Unique patients from denominators of all four gastro-intestinal bleed indicators.

Methodology: Numerator divided by denominator, presented as admissions per 10,000 patients at increased risk.

Reporting Level: Rolling 12 months aggregate results (most recent four quarters) at National, Regional and CCG level

Purpose: See GIB01, GIB02, GIB03 and GIB04

A detailed technical specification for this indicator is available from page 15 - 17 of this publication (prepared by NHS BSA)

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

Additional Polypharmacy Indicators

 

Indicator IP1.85

The average number of unique medicines prescribed per patient - for patients ≥85 years old (i-chart)

 

More information about this indicator

Definition: The average number of unique medicines prescribed per patient - for patients ≥85 years old

Numerator: Total number of unique medicines prescribed for patients,aged 85 and over, from BNF chapters 1 to 4 & 6 to 10

Denominator: Total number of patients, aged 85 and over, prescribed one or more medicines from BNF chapters 1 to 4 & 6 to 10

Please follow this link for a detailed technical specification ( on page 8 of this publication prepared by NHS BSA)

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

Indicator IP2.85

Percentage of patients prescribed 8≥ unique medicines and ≥85 years old

 

More information about this indicator

Definition: Percentage of patients prescribed 8≥ unique medicines and ≥85 years old

Numerator: Number of patients, aged 85 and over, prescribed 8 or more unique medicines

Denominator: Total number of patients, aged 85 and over, prescribed one or more medicines from BNF chapters 1 to 4 & 6 to 10

Please follow this link for a detailed technical specification ( on page 9 of this publication prepared by NHS BSA)

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

Indicator IP3.6

Percentage of patients with an anticholinergic burden score ≥9 (p-chart)

 

More information about this indicator

Definition: Percentage of patients with an anticholinergic burden score ≥9

Numerator: Number of patients prescribed one or more anticholinergic medicines with a combined anticholinergic burden (ACB) score of 9 or greater

Denominator: Total number of patients prescribed one or more medicines from BNF chapters 1 to 4 & 6 to 10

Please follow this link for a detailed technical specification ( on page 10 of this publication prepared by NHS BSA)

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

Indicator IP4

Percentage of patients prescribed medicines likely to cause Acute Kidney Injury DAMN (Diuretics/ACI&ARBs/Metformin/NSAIDS) drugs

 

More information about this indicator

Definition: Percentage of patients prescribed two or more unique medicines likely to cause kidney injury (DAMN medicines)

Numerator: Number of patients prescribed 2 or more unique medicines likely to induce, exacerbate or complicate acute kidney injury (DAMN medicines)

Denominator: Number of patients prescribed 1 or more unique medicines likely to induce, exacerbate or complicate acute kidney injury (DAMN medicines)

Please follow this link for a detailed technical specification ( on page 14 and 15 of this publication prepared by NHS BSA)

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

Indicator IP5

Percentage of patients prescribed a NSAID and ≥ 1 other unique medicines likely to cause kidney injury (DAMN drugs)

 

More information about this indicator

Definition: Percentage of patients prescribed a NSAID and one or more other unique medicines likely to cause kidney injury (DAMN medicines)

Numerator: Number of patients prescribed a NSAID and one or more other unique medicines likely to cause kidney injury (DAMN medicines)

Denominator: Number of patients prescribed 1 or more unique medicines likely to induce, exacerbate or complicate acute kidney injury (DAMN medicines)

Please follow this link for a detailed technical specification ( on page 16 and 17 of this publication prepared by NHS BSA)

Data for this indicator has been sourced from the ePACT2 data warehouse. Click here to login to ePACT2.

 

 

NB: Low volume figures have not been redacted and therefore individual patients may be identifiable. Please take care when disseminating data and contact your Caldicott Guardian for further guidance.