A change in the trend in dosulepin usage following the introduction of a prescribing indicator but not after two national safety warnings

Deslandes, Paul; Jenkins, Kathy; Haines, Kathryn; Hutchings, Sam; Cannings‐John, Rebecca; Lewis, Tracy; Bracchi, Robert; Routledge, Philip A.

doi:10.1111/jcpt.12376

Cited by 6 publications

(5 citation statements)

References 12 publications

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“…Of 11 466 identified articles, 40 studies examining UK medicines regulatory risk communications were included (Figure S1). These 40 studies examined the impact of 25 UK regulatory risk communications. Twelve of the 25 risk communications recommended a restriction of or change in medicine indication, 8 asked prescribers to be aware of new information about safety without explicit recommendations for action, 4 related to product withdrawals, and 1 to both restriction of indication and additional monitoring (Table and Table S1).…”

Section: Resultsmentioning

confidence: 99%

Impact of medicines regulatory risk communications in the UK on prescribing and clinical outcomes: Systematic review, time series analysis and meta‐analysis

Weatherburn

Guthrie

Dreischulte³

et al. 2019

Brit J Clinical Pharma

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Aims Regulatory risk communications are important to ensure medication safety, but their impact is poorly understood. The aim was to quantify the impact of UK risk communications on medication use and other outcomes. Methods We conducted a systematic review of studies reporting prescribing/health outcome data relevant to UK regulatory risk communication. Data were reanalysed using interrupted time series regression 12 months after each regulatory intervention. Mean changes were pooled using random‐effects generic inverse variance examining the following subgroups: drug withdrawals; restrictions/changes in indications; be aware messages without specific recommendations for action; communication via direct healthcare practitioner communications; communication via drug bulletins. Results Of 11 466 articles screened, 40 studies examining 25 UK regulatory risk communications were included. Product withdrawals, restriction in indications and be aware communications were associated with relative mean changes of −78% (95% confidence interval [CI] −60 to −96%), −34% (95% confidence interval [CI] −12 to −55%) and −11% (95%CI −8 to −15%) in targeted drug prescribing respectively. Direct healthcare professional communications were associated with relative mean changes of −47% (95%CI −27 to −68%) compared to −13% (95%CI −6 to −20%) for drug bulletins. Of 7 studies examining unique health outcomes related to the safety concern, risk communications were associated with a mean −10% (95%CI −3 to −16%) decrease in intended and a 7% (95%CI 4 to 10%) increase in unintended health outcomes. Discussion UK regulatory risk communications were associated with significant changes in targeted prescribing and potential changes in clinical outcomes. Further research is needed to systematically study the impact of regulatory interventions.

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Section: Resultsmentioning

confidence: 99%

Impact of medicines regulatory risk communications in the UK on prescribing and clinical outcomes: Systematic review, time series analysis and meta‐analysis

Weatherburn

Guthrie

Dreischulte³

et al. 2019

Brit J Clinical Pharma

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“…The trend in dosulepin usage in Wales altered significantly (downwards) following the introduction of the NPI. This association, and the observation of no significant change in North‐East England over the same period, suggested that the NPI and associated focus on the issue may have contributed to the effect seen 26 …”

Section: Resultsmentioning

confidence: 88%

The All Wales Medicines Strategy Group: 18 years' experience of a national medicines optimisation committee

Haines¹,

Bracchi²,

Lang³

et al. 2021

Brit J Clinical Pharma

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To review the medicines optimisation activities of the All Wales Medicines Strategy Group (AWMSG), a committee established in 2002 to advise the Welsh Government on "all matters related to prescribing". Although AWMSG conducts other activities (e.g., health technology appraisal for medicines), we focus here on its role in advising on medicines optimisation.Methods: Prescribing indicators have been used in Wales to measure change, together with data on volumes and costs of medicines dispensed. A range of improvement strategies have been categorised under the "four Es", namely educational initiatives, economic incentives, "engineering" and "enforcement".Results: AWMSG has helped health professionals in NHS Wales to reduce harm and waste, and to reduce inappropriate local or regional duplication and variation. Specific initiatives include the achievement of major cost savings by supporting increased generic prescribing and an "invest to save" approach related to prescribing of hypnotics and tranquillisers, non-steroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors. AWMSG also successfully commissioned the introduction of a single national in-patient medication chart for Wales in 2004. Ongoing priorities include a focus on reducing prescribing of certain medicines deemed "low value for prescribing" and on optimising the use of biosimilar medicines.Conclusions: Since 2002, AWMSG has acted as a national medicines optimisation committee in Wales. From the outset, pharmacists and clinical pharmacologists have collaborated closely and shared their complementary expertise to make a much greater contribution to the safe, effective and cost-effective use of medicines than either group could have achieved by working separately.

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“…Prescribing indicators have been used in the NHS for over 30 years to measure the quality and effectiveness of prescribing in GP. 19 20 Although there is some evidence of the effectiveness of the role of prescribing indicators in supporting improving quality in prescribing 21 particularly where they form part of multifaceted interventions, 22 23 they have been most commonly used to monitor changes in prescribing behaviour and cost over time. 24 Being shown to be an outlier can be an ‘eye opener’ and highlight priority areas for local action to change prescribing behaviour and improve quality.…”

Section: Resultsmentioning

confidence: 99%

Use of prescribing indicators as a means of identifying variation in the prevalence of valproate prescribing between health communities: a cross-sectional studyUse of prescribing indicators as a means of identifying variation in the prevalence of valproate prescribing between health communities: a cross-sectional study

Evans

Hinchliffe

Hood

et al. 2020

Integrated Healthcare Journal

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ObjectiveTo determine the appropriateness of valproate prescribing indicators in England and Wales as a means of identifying variation in the prevalence of valproate use among women and girls of childbearing potential between health communities.Methods and analysisCross-sectional study using an ecological design using routinely published, publicly available valproate prescribing data for the period January to March 2019 and 2018 mid-year population estimates.ResultsIn England and Wales, 87.7 people in every 1000 people prescribed valproate were women or girls aged 14–45 years (range 60.4–133.2). The prevalence of valproate use among all women and girls of childbearing age was 1.49 cases per 1000 women and girls aged 14–45 years (range 0.47–3.13). Considerable variation in prevalence was observed depending on which of two measures was used. The relative risk of exposure between health communities increased from 2.2 to 6.6 depending on the measure used, leading to the identification of different health communities being a priority for action. Wide variation was observed in the prevalence of valproate use among individuals other than women and girls aged 14–45 years (mean prevalence 3.89 cases per 1000 population, range 2.42–7.78). The prevalence of valproate use in all Clinical Commissioning Groups and Local Health Boards was lower in the at-risk population than in the rest of the population (p=0.046) with a strong positive correlation observed between the prevalence of valproate use in these two groups (p<0.001).ConclusionCurrent indicators may lead to a failure to systematically review women and girls of childbearing age prescribed valproate. Urgent consideration should be given to changing the indicators used in England and Wales.

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A change in the trend in dosulepin usage following the introduction of a prescribing indicator but not after two national safety warnings

Cited by 6 publications

References 12 publications

Impact of medicines regulatory risk communications in the UK on prescribing and clinical outcomes: Systematic review, time series analysis and meta‐analysis

Impact of medicines regulatory risk communications in the UK on prescribing and clinical outcomes: Systematic review, time series analysis and meta‐analysis

The All Wales Medicines Strategy Group: 18 years' experience of a national medicines optimisation committee

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