NATIONAL PRESCRIBING INDICATORS ANALYSIS OF PRESCRIBING DATA TO DECEMBER 2014

Transcription

1 NATIONAL PRESCRIBING INDICATORS ANALYSIS OF PRESCRIBING DATA TO DECEMBER 2014 May 2015

2 This report has been prepared by the Welsh Analytical Prescribing Support Unit (WAPSU), part of the All Wales Therapeutics and Toxicology Centre (AWTTC). Please direct any queries to AWTTC: All Wales Therapeutics and Toxicology Centre (AWTTC) University Hospital Llandough Penlan Road Llandough Vale of Glamorgan CF64 2XX This report should be cited as: Welsh Analytical Prescribing Support Unit, All Wales Therapeutics and Toxicology Centre. National Prescribing Indicators : Analysis of Prescribing Data to December May 2015.

3 SUMMARY The All Wales Medicines Strategy Group (AWMSG) endorses the National Prescribing Indicators (NPIs) as a means of promoting safe and cost-effective prescribing. For each NPI, the threshold is set at the 75 th percentile (i.e. reducing or increasing prescribing rates in line with the best performing 25% of practices). All practices within health boards are encouraged to reach or move towards these thresholds. For there are 14 NPIs focusing on seven areas of prescribing and the reporting of adverse events (Yellow Cards). A threshold level of prescribing is set for 11 of the 14 NPIs. This report summarises prescribing for the quarter ending December National prescribing of all medicines with an indicator threshold improved in line with the aim of the indicator for the quarter ending December 2014 compared with the same quarter of the previous year. During the first three financial quarters of , the number of Yellow Cards submitted per 100,000 population across Wales was greater than that seen in the equivalent period of National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 1 of 22

4 INTRODUCTION This report summarises the prescribing of medicines associated with an NPI for quarter (quarter ending December 2014). For a detailed explanation of the clinical relevance of these indicators please refer to For there are 14 NPIs focusing on eight areas of prescribing: Indicator Unit of measure Clinical relevance Lipid-modifying drugs Hypnotics and anxiolytics Items of LAC statins as a percentage of all statin, ezetimibe and simvastatin/ezetimibe combination prescribing ADQs per 1,000 STAR-PUs There are still savings to be made by some health boards through the use of LAC statins. Simvastatin, atorvastatin and pravastatin are the agents of choice. There is considerable variation in use of these medicines across health boards. Wales prescribes more hypnotic and anxiolytic items per 1,000 patients than demographically similar regions of England. Antidepressants ADQs per 1,000 STAR-PUs To monitor variation in prescribing across Wales. Opioid analgesics Antibiotics Insulin Non-steroidal antiinflammatory drugs (NSAIDs) Yellow Cards Total items per 1,000 PUs Items of morphine as a percentage of strong opioid prescribing Tramadol DDDs per 1,000 patients Total antibacterial items per 1,000 STAR-PUs Quinolones as a percentage of total antibacterial items Cephalosporins as a percentage of total antibacterial items Co-amoxiclav as a percentage of total antibacterial items Items of long-acting insulin analogues as a percentage of total long- and intermediate-acting insulin (excluding biphasics) NICE CG140 recommends oral modified-release morphine as first-line maintenance treatment for patients with advanced and progressive disease who require strong opioids. Tramadol has been associated with an increasing number of deaths and reports to the National Poisons Information Service. The NPIs support one of the key elements of the Welsh Antimicrobial Resistance Programme: to inform, support and promote the prudent use of antimicrobials. Public health guidance states Use simple generic antibiotics if possible. Avoid broad-spectrum antibiotics (e.g. co-amoxiclav, quinolones and cephalosporins) where narrow spectrum antibiotics remain effective. NICE CG87 recommends that when insulin therapy is necessary, human isophane (NPH) insulin is the preferred option. Long-acting insulin analogues offer no significant advantage and are more expensive. ADQs per 1,000 STAR-PUs There is overwhelming evidence to reduce prescribing of NSAIDs, especially in the elderly, due Ibuprofen and naproxen as a to the risk of gastro-intestinal, cardiovascular and percentage of NSAID items renal complications. Number of yellow cards submitted per practice and per health board To encourage reporting of adverse events. ADQ = average daily quantity; DDD = defined daily dose; LAC = low acquisition cost; PU = prescribing unit; STAR-PU = specific therapeutic group age sex related prescribing unit For each NPI, a threshold is set at the 75 th percentile (i.e. encouraging a reduction or increase in prescribing rates in line with the best performing 25% of practices). The NPI report for the quarter ending March 2015 will be available on the 11 July National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 2 of 22

5 1.0 LIPID-MODIFYING DRUGS This indicator aims to increase the prescribing of statins with a low acquisition cost (LAC) over more expensive lipid lowering treatments. Prescribing nationally has increased by 0.24% (in line with the aim of the indicator) compared to the equivalent quarter of the previous year. Figure 1 shows the trend in the proportion of LAC statin prescribing in the seven health boards in Wales from quarter to quarter Figure 1. Trend in LAC statin prescribing as a percentage of all statin, ezetimibe and simvastatin/ezetimibe combination prescribing Health Board ABMU Aneurin Bevan BCU Cardiff and Vale Cwm Taf Hywel Dda Powys Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr 2 Percentage Table 1 compares prescribing in quarter with quarter Prescribing above the national average is highlighted in green; prescribing below the national average is highlighted in blue. Table 1. LAC statins as a percentage of all statin, ezetimibe and simvastatin/ezetimibe combination prescribing Qtr Qtr 3 Change % Change ABMU % Aneurin Bevan % BCU % Cardiff and Vale % Cwm Taf % Hywel Dda % Powys % National average % Figure 2 compares prescribing across cluster groups for quarter with quarter National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 3 of 22

6 Figure 2. LAC statin prescribing as a percentage of all statin, ezetimibe and simvastatin/ezetimibe combination prescribing Quarter ending December 2013 versus quarter ending December 2014 Indicator ABMU Aneurin Bevan BCU Cardiff and Vale Cwm Taf Hywel Dda Powys Threshold LAC Statins as % of all Statins (Including ezetimibe combination products) Neath Penderi Upper Valleys Afan City Health Bridgend North Network Llwchwr Bridgend West Network Cwmtawe Bay Health Bridgend East Network Newport East Blaenau Gwent East Blaenau Gwent West Caerphilly North Newport West Caerphilly East Torfaen South Newport Central Caerphilly South Monmouthshire South Torfaen North Monmouthshire North North Denbighshire Dwyfor Holywell & Flint Arfon Meirionnydd Conwy East Anglesey South Wrexham Wrexham Town West & North Wrexham Conwy West Mold, Buckley & Caergwrle Central & South Denbighshire Deeside, Hawarden & Saltn.. City & Cardiff South Cardiff East Cardiff West Cardiff South West Cardiff South East Cardiff North Western Vale Central Vale Eastern Vale North Taf Ely North Rhondda South Rhondda South Cynon South Taf Ely North Cynon South Merthyr Tydfil North Merthyr Tydfil Amman/Gwendraeth North Pembrokeshire Taf / Teifi / Tywi South Ceredigion North Ceredigion South Pembrokeshire Llanelli Mid Powys South Powys North Powys Percentage National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 4 of 22 Quarter

7 2.0 HYPNOTICS AND ANXIOLYTICS This indicator aims to encourage a reduction in the prescribing of hypnotics and anxiolytics in Wales, which has been higher than that in England since before Prescribing nationally has decreased by 5.4% (in line with the aim of the indicator) compared to the equivalent quarter of the previous year. Figure 3 shows the trend in hypnotic and anxiolytic prescribing by health board from quarter to quarter Figure 3. Trend in hypnotic and anxiolytic prescribing ADQ per 1,000 STAR-PUs 5,000 4,500 4,000 3,500 Health Board ABMU Aneurin Bevan BCU Cardiff and Vale Cwm Taf Hywel Dda Powys 3,000 2, Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr 2 Table 2 compares prescribing in quarter with quarter Prescribing below the national average is highlighted in green; prescribing above the national average is highlighted in blue. Table 2. Hypnotic and anxiolytic ADQs per 1,000 STAR-PUs (13) Qtr Qtr 3 Change % Change ABMU 3,976 3, % Aneurin Bevan 3,986 3, % BCU 4,605 4, % Cardiff and Vale 3,433 3, % Cwm Taf 4,663 4, % Hywel Dda 4,216 4, % Powys 2,715 2, % National average 4,083 3, % National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 5 of 22

8 3.0 ANTIDEPRESSANTS This NPI was introduced in to monitor variation in prescribing across Wales; therefore no target has been set. Figure 4 shows the trend in antidepressant prescribing in the seven health boards in Wales from quarter to quarter Figure 4. Trend in antidepressant prescribing Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr 2 ADQ per 1,000 STAR-PUs Table 3 compares prescribing in quarter with quarter Prescribing below the national average is highlighted in green; prescribing above the national average is highlighted in blue. Table 3. Antidepressant ADQs per 1,000 STAR-PUs (13) Qtr Qtr 3 Change % Change ABMU % Aneurin Bevan % BCU % Cardiff and Vale % Cwm Taf % Hywel Dda % Powys % National average % National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 6 of 22

9 4.0 OPIOID ANALGESICS There are three indicators focusing on opioid prescribing for The indicators aim to encourage the appropriate prescribing of all opioid analgesics (including combination products containing codeine and dihydrocodeine 30 mg). 4.1 Total opioid items per 1,000 PUs No target is set for this indicator, as it is intended to be a comparator for the other NPIs. Figure 5 shows the trend in opioid analgesic prescribing in the seven health boards in Wales from quarter to quarter Figure 5. Trend in opioid analgesic prescribing (including combination products containing codeine and dihydrocodeine 30 mg) Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr 2 Items per 1,000 PUs Table 4 compares prescribing in quarter with quarter Prescribing below the national average is highlighted in green; prescribing above the national average is highlighted in blue. Table 4. Total opioid items per 1,000 PUs Qtr Qtr 3 Change % Change ABMU % Aneurin Bevan % BCU % Cardiff and Vale % Cwm Taf % Hywel Dda % Powys % National average % National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 7 of 22

10 4.2 Items of morphine as a percentage of strong opioid prescribing This indicator aims to encourage the use of morphine as first-line treatment in patients requiring strong opioid analgesics, in line with NICE recommendations. Prescribing nationally has increased by 8.3% (in line with the aim of the indicator) compared to the equivalent quarter of the previous year. Figure 6 shows the trend in morphine prescribing as a percentage of total opioid prescribing in the seven health boards in Wales from quarter to quarter Figure 6. Trend in morphine prescribing as a percentage of strong opioid prescribing Table 5 compares prescribing in quarter with quarter Prescribing above the national average is highlighted in green; prescribing below the national average is highlighted in blue. Table 5. Trend in morphine prescribing as a percentage of strong opioid prescribing Qtr Qtr 3 Change % Change ABMU % Aneurin Bevan % BCU % Cardiff and Vale % Cwm Taf % Hywel Dda % Powys % National average % Figure 7 compares prescribing across cluster groups for quarter with quarter National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 8 of 22

11 Figure 7. Morphine items as a percentage of strong opioid prescribing by cluster group Quarter ending December 2013 versus quarter ending December 2014 Indicator ABMU Aneurin Bevan BCU Cardiff and Vale Cwm Taf Hywel Dda Powys Quarter Threshold Morphine Items % of Strong Opioid Items /14 basket Penderi Cwmtawe Neath City Health Bridgend North Network Afan Llwchwr Bridgend East Network Bridgend West Network Upper Valleys Bay Health Caerphilly South Blaenau Gwent East Caerphilly East Caerphilly North Torfaen North Blaenau Gwent West Torfaen South Newport West Monmouthshire South Newport East Newport Central Monmouthshire North South Wrexham Conwy East West & North Wrexham Wrexham Town Anglesey Arfon Central & South Denbighshire North Denbighshire Conwy West Meirionnydd Deeside, Hawarden & Saltney Mold, Buckley & Caergwrle Holywell & Flint Dwyfor City & Cardiff South Cardiff South East Cardiff West Cardiff South West Western Vale Cardiff North Central Vale Cardiff East Eastern Vale North Merthyr Tydfil North Taf Ely South Taf Ely South Cynon South Merthyr Tydfil North Cynon South Rhondda North Rhondda North Pembrokeshire Taf / Teifi / Tywi South Pembrokeshire North Ceredigion South Ceredigion Llanelli Amman/Gwendraeth Mid Powys South Powys North Powys Percentage National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 9 of 22

12 4.3 Tramadol DDDs per 1,000 patients This NPI aims to encourage the prudent prescribing of tramadol, which has been associated with an increasing number of deaths and reports to the National Poisons Information Service. Prescribing nationally has decreased by 8.4% (in line with the aim of the indicator) compared to the equivalent quarter of the previous year. Figure 8 shows the trend in tramadol prescribing in the seven health boards in Wales from quarter to quarter Figure 8. Trend in tramadol prescribing Table 6 compares prescribing in quarter with quarter Prescribing below the national average is highlighted in green; prescribing above the national average is highlighted in blue. Table 6. Tramadol DDDs per 1,000 patients Qtr Qtr 3 Change % Change ABMU % Aneurin Bevan % BCU % Cardiff and Vale % Cwm Taf % Hywel Dda % Powys % National average % National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 10 of 22

13 5.0 ANTIBIOTICS There are four antibacterial prescribing indicators for : 1. Total antibacterial items per 1,000 STAR-PUs; 2. Quinolones as a percentage of total antibacterial items; 3. Cephalosporins as a percentage of total antibacterial items; 4. Co-amoxiclav as a percentage of total antibacterial items. 5.1 Total antibacterial items per 1,000 STAR-PUs This indicator supports one of the core elements of the Welsh Antimicrobial Resistance Programme: to inform, support and promote the prudent use of antimicrobials. Prescribing nationally has increased by 0.21% compared to the equivalent quarter of the previous year, although there was significant variation across the health boards. Figure 9 shows the seasonal trends in total antibiotic prescribing for the summer quarters (April September) and the winter quarters (October March) from to Figure 9. Trend in total antibiotic prescribing for summer and winter quarters Table 7 compares prescribing in quarter with quarter Prescribing below the national average is highlighted in green; prescribing above the national average is highlighted in blue. Table 7. Total antibacterial items per 1,000 STAR-PUs (13) Qtr Qtr 3 Change % Change ABMU % Aneurin Bevan % BCU % Cardiff and Vale % Cwm Taf % Hywel Dda % Powys % National average % National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 11 of 22

14 5.2 Quinolones, cephalosporins and co-amoxiclav Antibacterial prescribing indicators 2, 3 and 4 aim to reduce the prescribing of medicines associated with an increased risk of Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA) and resistant urinary tract infections. Figures 10, 11 and 12 show the seasonal trends in quinolone, cephalosporin and coamoxiclav prescribing for the summer quarters (April September) and the winter quarters (October March) from to Figure 10. Trend in quinolone prescribing as a percentage of total antibacterial items for summer and winter quarters Summer Winter Health Board ABMU Aneurin Bevan BCU Cardiff and Vale Cwm Taf Hywel Dda Powys % antibacterial items Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr 4 Figure 11. Trend in cephalosporin prescribing as a percentage of total antibacterial items for summer and winter quarters Summer Winter Health Board ABMU Aneurin Bevan BCU Cardiff and Vale Cwm Taf Hywel Dda Powys 7.0 % antibacterial items Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 12 of 22

15 Figure 12. Trend in co-amoxiclav prescribing as a percentage of total antibacterial items for summer and winter quarters Summer Winter Health Board ABMU Aneurin Bevan BCU Cardiff and Vale Cwm Taf Hywel Dda Powys % antibacterial items Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Figure 13 compares the prescribing of quinolones, cephalosporins and co-amoxiclav in quarter with quarter across the seven health boards in Wales. Figure 13. Antibiotic indicators 2 4 Quarter ending December 2013 versus quarter ending December 2014 Period ABMU Aneurin Bevan BCU Cardiff and Vale Cwm Taf Hywel Dda Powys National Average 2013/14 Qtr 3 Percentage antibacterial items /15 Qtr 3 Percentage antibacterial items Figures 14, 15 and 16 compare prescribing of each antibiotic or group of antibiotics across cluster groups for quarter with quarter National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 13 of 22

16 Figure 14. Quinolones as a percentage of total antibacterial items Quarter ending December 2013 versus quarter ending December 2014 Indicator ABMU Aneurin Bevan BCU Cardiff and Vale Cwm Taf Hywel Dda Powys 3.8 Quarter Quinolone items % of antibacterial Items Bay Health Llwchwr Upper Valleys Bridgend West Network Neath Bridgend East Network City Health Cwmtawe Afan Penderi Bridgend North Network Monmouthshire North Monmouthshire South Newport Central Torfaen South Caerphilly East Caerphilly North Caerphilly South Blaenau Gwent West Blaenau Gwent East Torfaen North Newport East Newport West West & North Wrexham Holywell & Flint Conwy East North Denbighshire Deeside, Hawarden & Saltney Central & South Denbighshire Mold, Buckley & Caergwrle Anglesey Conwy West Wrexham Town Arfon Meirionnydd Dwyfor South Wrexham Western Vale Cardiff South East Central Vale Eastern Vale Cardiff South West Cardiff North Cardiff West City & Cardiff South Cardiff East North Rhondda South Cynon South Rhondda North Taf Ely North Merthyr Tydfil South Taf Ely North Cynon South Merthyr Tydfil North Pembrokeshire Amman/Gwendraeth North Ceredigion Llanelli South Pembrokeshire South Ceredigion Taf / Teifi / Tywi North Powys South Powys Mid Powys Percentage Threshold National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 14 of 22

17 Figure 15. Cephalosporins as a percentage of total antibacterial items Quarter ending December 2013 versus quarter ending December 2014 Indicator ABMU Aneurin Bevan BCU Cardiff and Vale Cwm Taf Hywel Dda Powys 8.0 Quarter Cephalosporin items % of antibacterial Items Bridgend West Network Llwchwr Penderi Bay Health Upper Valleys City Health Neath Cwmtawe Afan Bridgend East Network Bridgend North Network Monmouthshire North Newport Central Caerphilly South Monmouthshire South Torfaen North Newport West Caerphilly East Torfaen South Blaenau Gwent East Blaenau Gwent West Newport East Caerphilly North West & North Wrexham Wrexham Town South Wrexham Deeside, Hawarden & Saltney Holywell & Flint Conwy West Dwyfor Central & South Denbighshire Conwy East Mold, Buckley & Caergwrle Anglesey Meirionnydd Arfon North Denbighshire Western Vale Eastern Vale Cardiff West Central Vale Cardiff North Cardiff East Cardiff South East Cardiff South West City & Cardiff South South Taf Ely South Merthyr Tydfil North Taf Ely North Cynon South Rhondda North Rhondda North Merthyr Tydfil South Cynon South Pembrokeshire Taf / Teifi / Tywi North Ceredigion Amman/Gwendraeth North Pembrokeshire Llanelli South Ceredigion South Powys North Powys Mid Powys Percentage Threshold National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 15 of 22

18 Figure 16. Co-amoxiclav as a percentage of total antibacterial items Quarter ending December 2013 versus quarter ending December 2014 Indicator ABMU Aneurin Bevan BCU Cardiff and Vale Cwm Taf Hywel Dda Powys Co-amoxiclav items % of antibacterial Items Llwchwr City Health Bay Health Upper Valleys Penderi Cwmtawe Bridgend West Network Neath Bridgend East Network Afan Bridgend North Network Monmouthshire South Monmouthshire North Newport Central Torfaen North Caerphilly North Newport East Blaenau Gwent West Newport West Caerphilly East Caerphilly South Torfaen South Blaenau Gwent East West & North Wrexham Deeside, Hawarden & Saltney Wrexham Town South Wrexham Mold, Buckley & Caergwrle Meirionnydd Central & South Denbighshire Arfon Anglesey Dwyfor Conwy West Holywell & Flint Conwy East North Denbighshire Western Vale Eastern Vale Cardiff East Cardiff South West Cardiff South East Cardiff North Central Vale City & Cardiff South Cardiff West South Taf Ely North Merthyr Tydfil North Taf Ely North Rhondda North Cynon South Merthyr Tydfil South Rhondda South Cynon South Pembrokeshire Taf / Teifi / Tywi North Ceredigion Amman/Gwendraeth North Pembrokeshire South Ceredigion Llanelli South Powys North Powys Mid Powys Percentage Threshold National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 16 of 22 Quarter

19 6.0 INSULIN This indicator aims to reduce the prescribing of long-acting insulin analogue items in favour of more cost-effective alternatives. Prescribing nationally has decreased by 1.3% (in line with the aim of the indicator) compared to the equivalent quarter of the previous year. Figure 17 shows the trend in long-acting insulin analogue items as a percentage of all long- and intermediate-acting insulin items (excluding biphasics) from quarter to quarter Figure 17. Trend in long-acting insulin analogue prescribing as a percentage of total long- and intermediate-acting insulin prescribing Table 8 compares prescribing in quarter with quarter Prescribing below the national average is highlighted in green; prescribing above the national average is highlighted in blue. Table 8. Long-acting insulin analogue prescribing as a percentage of total long- and intermediate-acting insulin prescribing (excluding biphasics) Qtr Qtr 3 Change % Change ABMU % Aneurin Bevan % BCU % Cardiff and Vale % Cwm Taf % Hywel Dda % Powys % National average % National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 17 of 22

20 7.0 NON-STEROIDAL ANTI-INFLAMMATORY DRUGS There are two non-steroidal anti-inflammatory drug (NSAID) NPIs for : 1. Total NSAID ADQs per 1,000 STAR-PUs 2. Ibuprofen and naproxen as a percentage of total NSAID items 7.1 Total NSAID ADQs per 1,000 STAR-PUs The first indicator aims to encourage a reduction in total NSAID prescribing, which has been consistently higher than that seen in England. Prescribing nationally has decreased by 3.8% (in line with the aim of the indicator) compared to the equivalent quarter of the previous year. Figure 18 shows the trend in total NSAID prescribing from quarter to quarter Figure 18. Trend in total NSAID prescribing Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr 2 ADQ per 1,000 STAR-PUs Table 9 compares prescribing in quarter with quarter Prescribing below the national average is highlighted in green; prescribing above the national average is highlighted in blue. Table 9. Total NSAID ADQs per 1,000 STAR-PUs (13) Qtr Qtr 3 Change % Change ABMU 1,958 1, % Aneurin Bevan 1,925 1, % BCU 1,866 1, % Cardiff and Vale 1,902 1, % Cwm Taf 1,936 1, % Hywel Dda 1,870 1, % Powys 1,904 1, % National average 1,907 1, % National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 18 of 22

21 7.2 Ibuprofen and naproxen as a percentage of NSAID items The second NSAID indicator aims to increase the prescribing of ibuprofen and naproxen, because these drugs are associated with a lower risk of cardiovascular adverse events than other NSAIDs. Prescribing nationally has increased by 4.0% (in line with the aim of the indicator) compared to the equivalent quarter of the previous year. Figure 19 shows the trend in ibuprofen and naproxen prescribing from quarter to quarter Figure 19. Trend in ibuprofen and naproxen prescribing as a percentage of NSAID items 85 Health Board ABMU Aneurin Bevan BCU 80 Cardiff and Vale Cwm Taf Hywel Dda 75 Powys Percentage Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr Qtr 2 Table 10 compares prescribing in quarter with quarter Prescribing above the national average is highlighted in green; prescribing below the national average is highlighted in blue. Table 10. Ibuprofen and naproxen items as a percentage of NSAID items Qtr Qtr 3 Change % Change ABMU % Aneurin Bevan % BCU % Cardiff and Vale % Cwm Taf % Hywel Dda % Powys % National average % Figure 20 compares prescribing across cluster groups for quarter with quarter National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 19 of 22

22 Figure 20. Ibuprofen and naproxen as a percentage of NSAID items Quarter ending December 2013 versus quarter ending December 2014 Indicator ABMU Aneurin Bevan BCU Cardiff and Vale Cwm Taf Hywel Dda Powys 90 Quarter Threshold Ibuprofen And Naproxen as % of NSAIDs Neath Afan Llwchwr Bay Health City Health Cwmtawe Penderi Upper Valleys Bridgend East Network Bridgend North Network Bridgend West Network Newport West Caerphilly North Blaenau Gwent West Torfaen North Torfaen South Caerphilly South Caerphilly East Newport Central Blaenau Gwent East Monmouthshire North Monmouthshire South Newport East Wrexham Town Deeside, Hawarden & Saltney Conwy West South Wrexham Mold, Buckley & Caergwrle Arfon Conwy East West & North Wrexham Meirionnydd North Denbighshire Central & South Denbighshire Holywell & Flint Anglesey Dwyfor City & Cardiff South Cardiff East Central Vale Cardiff South West Cardiff West Cardiff North Cardiff South East Eastern Vale Western Vale North Taf Ely South Rhondda North Merthyr Tydfil South Cynon South Taf Ely North Cynon North Rhondda South Merthyr Tydfil Llanelli North Ceredigion North Pembrokeshire South Pembrokeshire Amman/Gwendraeth Taf / Teifi / Tywi South Ceredigion Mid Powys South Powys North Powys Percentage National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 20 of 22

23 8.0 YELLOW CARDS This is a new indicator for The Yellow Card Scheme is vital in helping the Medicines and Healthcare products Regulatory Agency (MHRA) monitor the safety of medicines and vaccines. The purpose of this indicator is to increase the number of Yellow Cards submitted by GPs in Wales, and these figures are monitored by the Yellow Card Centre (YCC) Wales. Figure 21 shows the trend in the number of Yellow Card reports submitted by GPs in the seven health boards in Wales per 100,000 population from quarter to quarter Figure 21. Trend in Yellow Card reporting National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 21 of 22

24 GLOSSARY ADQ The average daily quantity (ADQ) is a measure of prescribing volume based upon prescribing behaviour in England. It represents the assumed average maintenance dose per day for a medicine used for its main indication in adults. The ADQ is not a recommended dose but an analytical unit to compare prescribing activity. DDD The defined daily dose (DDD), developed by the World Health Organisation, is a unit of measurement whereby each medicine is assigned a value within its recognised dosage range. The value is the assumed average maintenance dose per day for a medicine when used for its main indication in adults. A medicine can have different DDDs depending on the route of administration. PU Prescribing units (PUs) were adopted to take account of the greater need of elderly patients for medication in reporting prescribing performance at both the practice and primary care organisational level. PRESCRIBING Although the term prescribing is used in this report, the data presented represent prescriptions that have been dispensed and forwarded for pricing. It is assumed that the difference between the number of prescriptions issued and those dispensed is not significant, and that dispensing provides an accurate representation of prescribing. STAR-PU Specific therapeutic group age-sex related prescribing units (STAR-PUs) are designed to measure prescribing weighted for age and sex of patients. There are differences in the age and sex of patients for whom medicines in specific therapeutic groups are usually prescribed. To make such comparisons, STAR-PUs have been developed based on costs of prescribing of items within therapeutic groups. National Prescribing Indicators Analysis of Prescribing Data to December 2014 Page 22 of 22