Aims

To pilot two dashboards to monitor prescribing of metformin and aspirin according to the National Institute for Health and Care Excellence (NICE) ‘Do-Not-Do’ recommendations.

Methods

This quality assurance programme was conducted in twelve general practices of the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network. We developed dashboards to flag inappropriate prescribing of metformin and aspirin to people with type 2 diabetes mellitus (T2DM). In Phase 1, six practices (Group A) received a dashboard flagging suboptimal metformin prescriptions in people with reduced renal function. The other six practices (Group B) were controls. In Phase 2, Group B were provided a dashboard to flag inappropriate aspirin prescribing and Group A were controls. We used logistic regression to explore associations between dashboard exposure and inappropriate prescribing.

Results

The cohort comprised 5644 individuals (Group A, n = 2656; Group B, n = 2988). Half (51.6%, n = 2991) were prescribed metformin of which 15 (0.5%) were inappropriate (Group A, n = 10; Group B, n = 5). A fifth (17.6%, n = 986) were prescribed aspirin of which 828 (84.0%) were inappropriate. During Phase 1, metformin was stopped in 50% (n = 5) of people in Group A, compared with 20% (n = 1) in the control group (Group B); in Phase 2, the odds ratio of inappropriate aspirin prescribing was significantly lower in practices that received the dashboard versus control (0.44, 95%CI 0.27−0.72).

Conclusions

It was feasible to use a dashboard to flag inappropriate prescribing. Whilst underpowered to report a change in metformin, we demonstrated a reduction in inappropriate aspirin prescribing.

中文翻译：

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减少二甲双胍和阿司匹林不当处方的仪表板：初级保健哨点网络中的质量保证计划

目标

根据美国国家健康与护理卓越研究所 (NICE) 的“不做”建议，试行两个仪表板来监测二甲双胍和阿司匹林的处方。

方法

该质量保证计划是在牛津皇家全科医师学院 (RCGP) 研究和监视中心 (RSC) 网络的十二个全科诊所中进行的。我们开发了仪表板来标记二甲双胍和阿司匹林对 2 型糖尿病 (T2DM) 患者的不当处方。在第 1 阶段，六家诊所（A 组）收到了一个仪表板，用于标记肾功能下降患者的二甲双胍处方次优。其他六种做法（B 组）是对照。在第 2 阶段，为 B 组提供了一个仪表板来标记不适当的阿司匹林处方，而 A 组是对照组。我们使用逻辑回归来探索仪表板暴露与不当处方之间的关联。

结果

该队列包括 5644 人（A 组，n = 2656；B 组，n = 2988）。一半（51.6%，n = 2991）开了二甲双胍，其中 15 个（0.5%）不合适（A 组，n = 10；B 组，n = 5）。五分之一（17.6%，n = 986）的人服用了阿司匹林，其中 828 人（84.0%）不合适。在第 1 阶段，A 组 50%（n = 5）的人停止使用二甲双胍，而对照组（B 组）的这一比例为 20%（n = 1）；在第 2 阶段，在接受仪表板的实践中，与对照组相比，不适当的阿司匹林处方的优势比显着降低 (0.44, 95% CI 0.27-0.72)。

结论

使用仪表板标记不适当的处方是可行的。虽然报告二甲双胍变化的能力不足，但我们证明了不适当的阿司匹林处方减少了。