Atlas of Healthcare Variation

Transcription

1 Atlas of Healthcare Variation Webinar 4: From atlases to action Make sure you have your pc and phone connected (see instructions ed to you) You will be muted during the webinar to reduce background noise This webinar will be recorded Use the public chat or Q&A tab to post a question during the webinar

2 Atlas of Healthcare Variation Webinar 4: From Atlases to action Dr Alan Davis Clinical Director Catherine Gerard Senior Analyst

3 Outline of webinar Present on Scope of the Campaign and the Collaborative Variations analyses and the Opioids Atlas How to use the Atlas data for quality improvement Opportunity for questions from the audience

4 Introduction Campaign focus is on reducing error and harm from high risk medicines National safe use of opioids collaborative is a partnership between DHBs and the Commission running until April 2016 Atlas supports this work by describing community use of opioids and identifying DHB variation.

5 Campaign focus to date Month October November Focus Case for change Identifying and mitigating error and harm December & January February March Partnering with patients and their whanau Preventing error and harm Safe use of opioids

6 Safe use of opioids Opioids are very effective in managing severe pain But they are high risk and commonly implicated in harm: Over-sedation Respiratory depression Other common adverse effects: nausea, vomiting, constipation, delirium, hallucinations, falls, hypotension, aspiration pneumonia, and addiction.

7 Atlases

8 Taxonomy of variation 1 Effective care Preference-sensitive care Supply-sensitive care Appleby, Raleigh, Frosini et al. Variations in health care: the good, the bad and the inexplicable. Kings Fund (2011).

9 Unwarranted variation Jack Wennberg: Variation in the utilization of health care services that cannot be explained by variation in patient illness or patient preferences.

10 Measuring variation Tin openers and dials Concept from Carter and Klein Tin openers open up cans of worms Dials measure things

11 This is not a league table High is not necessarily better Low may not be worse The middle might not be right

12 Method Rate/1,000 population receiving: Strong opioids: fentanyl, methadone, morphine, oxycodone and pethidine Weak opioids: tramadol, codeine and dihydrocodeine Sub-analyses by year ( ), age, ethnicity and gender

13 Atlas of healthcare variation Opioid dispensing by community pharmacies: hospital discharge and primary care prescriptions Shows the rate of opioid use by DHB of domicile No ideal rate is known but wide variation may highlight areas of under- and overuse

14 View atlas and explain how to view and different ways of presenting the data

15 Key findings strong opioids 3-fold variation Used more: European/Other 2-4 times rate Increased significantly with age, on average 1 in 10 people aged 80+ in 2013 Women > men 46% had a public hospital event associated with dispensing 14% of people (9,300) receiving a strong opioid received it for 6 or more weeks. Oxycodone use decreased from

16 Key findings weak opioids 2-fold variation Used more: European/Other Increased with age, up to 1 in 7 people aged 80+ Women > men

17 These data raise questions Why do some DHBs have consistently higher rates? Why are there marked ethnic differences? What other combinations of medicines are people on strong opioids receiving, eg benzodiazepine use?

18 Suggested actions Resources for variations analyses on the Commission website Review number of prescribers Review other medications What is the variation by practice /practitioner?

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20 Number of prescribers?

21 What other medications? 46% people dispensed a strong opioid for 6 or more weeks also received benzodiazepine/ zopiclone

22 Links to resources Opioids atlas: Guides: Webinars: Please use Q&A function to ask questions